Amendment No. 25 is being taken with amendment No. 24.
Nurses Bill, 1984: Committee Stage (Resumed).
Debate resumed on amendment No. 24.
In page 17, subsection (2), line 26, aftr "nurse" to insert ", but the Training Schools shall select their own candidates for nurse training".
—(Deputy O'Hanlon.)
I do not have anything further to add to what I said about the amendments. I dealt with the matter fully on the last occasion.
On the last occasion the Minister, when replying to my amendment which seeks to give right to a training school to select their own students, elaborated on what is in the Bill. From what he said it is obvious that he intends that the central applications bureau will have the right to select student nurses and send them to a particular training school. That is entirely unacceptable to us. First, there is the employer-employee relationship that exists in hospitals — student nurses are employees of hospitals, the training schools — and we cannot lose sight of that. It would be wrong that student nurses should be sent to a training school without that training school having a say in the selection process.
There is also the question of the character and ethos of the hospitals. I should like to ask the Minister how his ideas on the method of selection would be in keeping with the Hospitals Federation and Amalgamation Act, 1961, which made it clear that An Bord Altranais would not interfere with the autonomy of the nursing school attached to any participating hospital of a particular denominational character. We believe that the employing authority must have the right of selection to ensure that they are able to maintain the character and ethos of the hospital. I cannot say how the central applications bureau as proposed by the Minister will ensure a fairer system. If there is any unfairness in the present system it can be eliminated without introducing a system whereby An Bord Altranais, through their central applications bureau, will send students to a particular training school. Our amendment should be accepted. It is very important that the training school have the final say in the selection of students to their school.
Amendment put.
The Committee divided: Tá, 61; Níl, 70.
Tá
- Ahern, Bertie.
- Ahern, Michael,
- Barrett, Michael.
- Brady, Vincent.
- Brennan, Mattie.
- Brennan, Paudge.
- Brennan, Séamus.
- Browne, John.
- Burke, Raphael P.
- Byrne, Hugh.
- Byrne, Seán.
- Calleary, Seán.
- Conaghan, Hugh.
- Connolly, Ger.
- Coughlan, Cathal Seán.
- Cowen, Brian.
- Daly, Brendan.
- Doherty, Seán.
- Fahey, Francis.
- Fahey, Jackie.
- Faulkner, Pádraig.
- Flynn, Pádraig.
- Foley, Denis.
- Gallagher, Denis.
- Gallagher, Pat Cope.
- Geoghegan-Quinn, Máire.
- Harney, Mary.
- Haughey, Charles J.
- Hyland, Liam.
- Kirk, Séamus.
- Kitt, Michael.
- Lenihan, Brian.
- Leonard, Jimmy.
- Leonard, Tom.
- Leyden, Terry.
- Lyons, Denis.
- McCarthy, Seán.
- McCreevy, Charlie.
- McEllistrim, Tom.
- Molloy, Robert.
- Morley, P. J.
- Moynihan, Donal.
- Nolan, M. J.
- Noonan, Michael J. (Limerick West)
- O'Connell, John.
- O'Dea, William.
- O'Hanlon, Rory.
- O'Keeffe, Edmond.
- O'Kennedy, Michael.
- O'Leary, John.
- Ormonde, Donal.
- O'Rourke, Mary.
- Power, Paddy.
- Reynolds, Albert.
- Treacy, Noel.
- Tunney, Jim.
- Wallace, Dan.
- Walsh, Joe.
- Walsh, Seán.
- Wilson, John P.
- Wyse, Pearse.
Níl
- Barnes, Monica.
- Barrett, Seán.
- Barry, Myra.
- Begley, Michael.
- Bell, Michael.
- Bermingham, Joe.
- Birmingham, George Martin.
- Boland, John.
- Bruton, Richard.
- Carey, Donal.
- Cluskey, Frank.
- Collins, Edward.
- Conlon, John F.
- Connaughton, Paul.
- Coogan, Fintan.
- Cooney, Patrick Mark.
- Cosgrave, Liam T.
- Cosgrave, Michael Joe.
- Coveney, Hugh.
- Creed, Donal.
- Crowley, Frank.
- D'Arcy, Michael.
- Deasy, Martin Austin.
- De Rossa, Proinsias.
- Desmond, Barry.
- Desmond, Eileen.
- Donnellan, John.
- Noonan, Michael. (Limerick East)
- O'Brien, Fergus.
- O'Brien Willie.
- O'Sullivan, Toddy.
- O'Toole, Paddy.
- Owen, Nora.
- Pattison, Séamus.
- Prendergast, Frank.
- Dowling, Dick.
- Doyle, Avril.
- Dukes, Alan.
- Durken, Bernard J.
- Enright, Thomas W.
- Farrelly, John V.
- Fennell, Nuala.
- FitzGerald, Garret.
- Flanagan, Oliver J.
- Glenn, Alice.
- Gregory-Independent, Tony.
- Griffin, Brendan.
- Harte, Patrick D.
- Hegarty, Paddy.
- Hussey, Gemma.
- Kelly, John.
- Kenny, Enda.
- McGinley, Dinny.
- Mac Giolla, Tomás.
- McLoughlin, Frank.
- Manning, Maurice.
- Mitchell, Jim.
- Molony, David.
- Moynihan, Michael.
- Naughten, Liam.
- Nealon, Ted.
- Quinn, Ruairí.
- Ryan, John.
- Shatter, Alan.
- Sheehan, Patrick Joseph.
- Spring, Dick.
- Taylor, Mervyn.
- Taylor-Quinn, Madeline.
- Timmins, Godfrey.
- Yates, Ivan.
Tellers: Tá, Deputies V. Brady and Barrett.(Dublin North-West); Níl, Deputies Barrett (Dún Laoghaire) and Taylor.
Amendment declared lost.
Amendment No. 25 was discussed with amendment No. 24. Is amendment No. 25 withdrawn?
I move amendment No. 25:
In page 17, lines 27 to 30, to delete subsection (3).
I understood from the Minister that he accepts this amendment and will propose a similar amendment on Report Stage. Perhaps the Minister has something to say.
I can give the Deputy an assurance that I am prepared to examine his amendment and introduce an appropriate formulation on Report Stage.
Amendment, by leave, withdrawn.
Section 36 agreed to.
SECTION 37.
Amendment No. 27 is an alternative to amendment No. 26. The two amendments may be discussed together by agreement. If amendment No. 26 is accepted amendment No. 27 may not be moved.
I move amendment No. 26:
In page 17, subsection (1), line 31, to delete "from time to time" and substitute "at least once in every four years".
"From time to time" is not an appropriate phrase. It is a very vague phrase to use in the Bill. It can be rather meaningless. Our amendment proposes to put a specific number of years in the Bill, that is, four years, so that there will be some certainty about the decision of the board. Subsection (1) provides:
The Board shall, from time to time, satisfy itself as to—
(a) the suitability of education and training for nurses provided by any hospital,...
(b) the standards of theoretical and practical knowledge required for examinations,
They could be left for a period of ten years. There could be enormous changes in the practice of medicine. The board has to satisfy itself as to the clinical training and experience provided in any training programme and the adequacy and suitability of post registration training courses for nurses. Continuous training courses after registration are often neglected for fairly long periods. It is essential for the proper running of the board and maintaining the proper standards in the nursing profession that the phrase "from time to time" should be replaced by "at least once in every four years".
My amendment proposes that at least once in every five years the board would satisfy itself as to the suitability of the standards of nurse education and training. The phrase "from time to time" is not satisfactory. There should be a set period of time within which the board would satisfy itself as to the suitability of the training establishments.
I also believe there should be some definite time in the Bill. As it stands, it is rather vague. I would have two worries if we do not set down a specific time. First, the board could go on for ten or 15 years without assessing the suitability or otherwise of the nursing schools. There is the other danger that we could hassle them every two or three months. For that reason we should provide a specific time, perhaps four or five years.
As Deputies are aware, education and training is an on-going process and one I would be somewhat reluctant to see constrained by specific time limits. That is the reason I had originally inserted the phrase "from time to time", seeing it as an appropriate one to be used in relation to those functions. I was rather anxious that account be taken of the necessarily continuous nature of the functions themselves. I might equally make the point to Deputies that advances in medicine and, consequently, in nursing care take place so rapidly that training courses must strive constantly to keep abreast of such developments.
That was the general thrust of the initial part of that section. However, in deference to those who have proposed these amendments, I would be prepared to agree that we might reach agreement on Report Stage on a particular formulation of words, though perhaps not as specific as Deputies Mac Giolla, De Rossa or O'Hanlon had recommended. Perhaps we could use a phrase such as "not more than five years", leaving it somewhat more flexible without tying it down to once every four years or once every five years — say "in a period of not more than five years". I would be prepared to introduce an amendment along those lines on Report Stage.
Then I withdraw my amendment.
And I withdraw mine.
Amendment No. 26, by leave, withdrawn.
Amendment No. 27 not moved.
Question proposed: " That section 37 stand part of the Bill."
In relation to the functions of the board regarding training, what would be the position of the board, say, in non-registration courses? Would the board have any powers in terms of providing courses that are not related directly to registration?
My other question relates to subsection (3) which reads:
The Board may maintain statistical records and make such records available for research and planning, including manpower planning purposes.
Would the privacy of the individual be placed at risk there?
The essential point of the question raised by Deputy O'Hanlon is that the board will not be running courses but will have to satisfy themselves as to the suitability and adequacy of all courses of nursing education and training both at pre-and post-registration levels. Subsection (1) is a new provision. Therefore the non-registration or pre-registration courses could be encompassed within the work of the board. I can give the Deputy an assurance in relation to manpower planning purposes and general statistical records that, of course, confidentiality will be maintained. I would be particularly anxious that such be maintained by the board, as is the case in regard to general health records because quite sensitive material may be on the records and in the hands of very young people in terms of their training.
Question put and agreed to.
Section 38 agreed to.
SECTION 39.
I move amendment No. 28:
In page 18 subsection (1) (b), line 18, to delete "fitness", and substitute "unfitness".
This amendment is on the recommendation of the parliamentary draftsman to remedy a defect in the phraseology of the Bill and has no other import at present.
Amendment agreed to.
Amendment No. 29 in the name of the Minister. Amendments Nos. 37 and 46 are cognate. Amendments Nos. 29, 37 and 46 to be discussed together by agreement.
I move amendment No. 29:
In page 20, subsection (7), line 8, to delete "£500", and substitute "£1,000".
In this instance, on page 20, subsection (7), line 8, we are deleting £500 and substituting £1,000. We are doing precisely that on page 25, line 29, again deleting £500 and substituting £1,000 and on page 27, section 59 (2), again deleting £500 and substituting £1,000. These amendments increase the level of fines in three areas of the Bill in which fines are imposed in order to keep pace directly with inflation.
Amendment agreed to.
Question proposed: "That section 39, as amended, stand part of the Bill".
This has to do with the fitness to practise committee. For health or other reasons it is desirable that this be dealt with separately so that no nurse can be brought to account on both counts.
I am sorry, a Leas-Cheann Comhairle, I am not prepared; I had thought Deputy Mac Giolla was coming in before me and I have not got what I wanted to say prepared. Perhaps I may come in after him.
I wanted to make some observations on this section. I have been going through it for some time and am most disturbed at some of its implications. I was unable to amend it suitably. I have some comments I would ask the Minister to take on board with regard to the part on fitness to practise. I am not worried about the board having the power to hear reasons that a nurse, through her or his misconduct, is not fit to practise — that is a general power afforded professional bodies. This is a professional body and professional conduct must be maintained.
What really concerns me is the provision in subsection (1) (b), which says:
alleged fitness to engage in such practice by reason of physical or mental disability,
which is open to grave abuse and carries great dangers for the nursing profession. I do not see anything in it which protects the disabled, their jobs or that affords them permanence of employment. If they are found unfit to practise the profession of nursing due to a physical disability, are they out of a job for life? Surely our job should be to protect the jobs of disabled persons? Perhaps the services of nurses who are not able to work on wards could be utilised in administration or in laboratories. This does not seem to be allowed for in the Bill; when you come before the board and are declared unfit to perform all the duties of the nursing profession due to physical disability, you are no longer a nurse and are struck off the register.
The same applies to mental disability which is much more difficult to assess. There is not sufficient protection in the Bill to ensure that people are not moved from the register unnecessarily perhaps because of a period of mental stress when they require medical and nursing care themselves for some time to bring them back to full health. The nurse should be given sufficient sick leave, maybe 12 months, to overcome the particular mental or physical disability but, instead, they will be brought before the board after a month or two and declared unfit to practise the profession of nursing. That area is wide open to abuse; it is not in the best interests of nurses or the concern and care which we should ensure is enshrined in the legislation for physically or mentally unwell people. We talk a lot about the care of the physically handicapped, the deaf and the blind, in relation to employment and we should ensure that they get the work which they are capable of doing in spite of their disabilities. In this Bill there is a great danger that we are excluding anybody who has a physical or mental disability, even of a temporary nature.
There are nearly three pages in the Bill in relation to the Unfitness to Practise Committee and the procedure to be adopted by them or the board. They may be directed by the board to carry out an inquiry or they may carry out an inquiry themselves if someone suggests that a person is unfit to practise because of misconduct, physical or mental disability. I was unable to formulate appropriate amendments to this section but I am asking the Minister to ensure that nurses will not lose their jobs because of physical disability if they are capable of doing some other job within the health care or nursing areas. I hope the Minister will find a way to ensure that these nurses are not struck off the register.
Nurses often injure themselves in the course of their duties and a physical disability would be obvious. I am sure that problem would be dealt with fairly but the question of mental disability and misconduct are distinct and separate. Nurses under strain can often act in ways which are related to a nervous breakdown. I know of such cases and a mental disability can be as temporary as a physical disability. However, when nurses change employment from one hospital to another, a confidential report follows them. The nurse is question may not even know that there is a reference to her mental disability and, although she is cured, it can be a deciding factor in future employment opportunities. A nurse may be under stress working in a particular hospital where the environment is not conducive to her wellbeing. She may have a nervous breakdown and, by having treatment and being reassigned to another hospital, she may be completely cured. By this report following her to her new place of employment, her career could be permanently damaged and she might have to make do with a lesser status in order to remain in employment. I am very concerned about this.
Where a nurse is brought to account because of misconduct or the need to analyse her actions because of mental or physical disability, it is essential that all the details relating to her case should be available to the nurse in question. Often nurses are given no chance to defend themselves, which is wrong and unfair. The Minister must ensure that they are given a copy of the charges against them in time to get legal advice if necessary. Mental disability or temporary breakdown should not be an inhibiting factor in the rest of their nursing life. Many nurses are under severe strain at present because of the trauma of accidents and so on and young girls often have setbacks but that should not affect the rest of their career.
When the board or any other person applies for an inquiry, they should first ensure that they are satisfied that the nurse in question has been given an opportunity to work in a number of different areas. While, for example, a nurse may be unfit physically for work in one area, she might be competent in another area. For instance, she might be capable of working in the central supply area of a hospital but not capable of working on a busy ward. I should like an assurance that when an inquiry of this kind is initiated those responsible would ensure that the nurse be given an opportunity of working in various areas in the hospital.
The other matter I wish to refer to relates to section 39 (1) (a) and (b). It appears a little insensitive to group alleged professional misconduct with alleged unfitness to practise by reason of physical or mental disability. One would have thought that this could have been dealt with in a different way, that perhaps there would have been a distinction between procedures for processing cases in each of these categories.
I agree with the last point raised by Deputy Faulkner. Fitness to practise committees serve to protect the public and to maintain the standards of the professions. There is a section in the legislation relating to the Medical Council which is similar to this section here and I do not think there has been any complaint from members of the medical profession about inquiries suffered as a result of the section. However, I can appreciate the concern of many nurses, particularly in relation to subsection (1) (b).
Deputy Faulkner has highlighted the point that on the surface it appears unreasonable to group together alleged professional misconduct and the question of alleged unfitness to practise by reason of physical or mental disability. I understand that other European countries have moved away from this concept. The recent legislation in the UK provided for procedures to improve the protection of the public by considering cases in which it is alleged that a nurse is no longer safe to practise because of illness rather than by virtue of being guilty of some culpable action. In the UK cases considered necessary to be put forward for hearing before the professional conduct committee must take place in law. If the investigation concerns alleged unfitness to engage in practise by reason of physical or mental disability, the hearing is in private; but it is interesting that, if at the initial investigation the person concerned appears unfit to practise because of illness, the case is viewed by a group of three professional screeners who are nurse members of the central council. The nurse undergoes an independent medical examination and the report from that is sent to the professional screeners. If illness is indicated, the nurse is referred to a health committee who may decide on the outcome; but in the case of professional misconduct the case will be dealt with in the ordinary way, that is, through the fitness to practise committee. Nurses here consider that something similar would be appropriate to this country and that investigations into alleged unfitness to practise by reason of physical or mental disability should be dealt with in a way that is different from the way in which the alleged professional misconduct is dealt with. Perhaps the Minister will consider this point between now and Report Stage.
The only other point raised on the section relates to the information to be given to a person who is to be investigated by the fitness to practise committee. Subsection (4) of section 39 provides that the CEO would forward by way of pre-paid post to the address of the person as stated in the register notice of the nature of the evidence proposed to be considered at the inquiry. The point has been made that there should be more evidence and that the nurse who is about to be investigaged should have full information as to matters to be brought before the committee. In such cases the letters should be sent by registered post rather than by pre-paid post so as to ensure that they reach those for whom they are intended.
I, too, consider it somewhat insensitive to group together the matters referred to in paragraphs (a) and (b) of subsection (1). Is there any possibility of introducing an amendment to separate the two, because there is a major difference between alleged professional misconduct and alleged unfitness to practise?
My other concern relates to a submission made to me — and made also to the Minister, I understand — from the Psychiatric Nurses Association in which they express fears about the possibility of duplication. We all agree on the need for a fitness to practise provision but these nurses are concerned that there may be duplication between the fitness to practise committee and what they refer to as the existing stringent disciplinary procedure laid down by employing authorities. These nurses express the fear that they may be accountable to two bodies, to their employer and to the board, in relation to the performance of their duties. They say also that there must be a clear understanding of what is appropriate for processing through agreed management-trade union procedures and what is appropriate for the fitness to practise committee. The PNA are concerned that involvement in a legitimate industrial dispute could result in a nurse being reported for professional misconduct or in her being accountable for involvement in some incident occurring outside normal working hours. The nurses are concerned that they could be found unfit to practise for one reason rather than the other. I should like the Minister to comment on that.
I can appreciate readily the concern of Members with this very difficult section, a section which understandably could give rise to certain facts. First, the inclusion of a provision denying permission to continue in practice for reasons of physical or mental disability is largely a matter of convenience in drafting. That section has stood the test of time in the Act dealing with medical practitioners and now it is proposed for the Dentists Bill. I think it will also stand the test of time there.
It is true, for example, that nurse may suffer from drug addiction or schizophrenia. In that connection the board or any person may apply to the fitness to practise committee to determine whether the nurse in question should be permitted to continue to practise as a nurse. It is a very serious matter. In the first instance the committee would have to consider the application under section 39(2) and then they would have to satisfy themselves "that there is not sufficient cause to warrant the holding of an inquiry". If the evidence is there the committee would have to hold an inquiry, but clearly the evidence would have to exist. This is particularly so because this is an area where one is dealing with subjective judgments and one would have to be exceptionally careful. I have not the slightest doubt but that the greatest care would be exercised in such a case. Equally, the rights of the person concerned have to be protected fully and I wish to reassure Deputy Glenn, Deputy De Rossa and others who have raised this matter. The nature of the evidence proposed to be considered would have to be conveyed to the person concerned. Section 39(4) states:
When it is proposed to hold an inquiry under subsection (3) of this section the person who is the subject of the inquiry shall be given notice in writing by the Chief Executive Officer sent by pre-paid post to the address of that person as stated in the register of the nature of the evidence proposed to be considered at the inquiry...
In effect, one is virtually talking of a High Court case, of a Book of Evidence being produced. Subsections (3) to (7) deal with witnesses appearing before the fitness to practise committee. They will be given the same immunity and privileges as if they were witnesses in the High Court. A person making a serious allegation about another who is engaged in the practice of nursing would have to get protection in the giving of that evidence and would have the same privileges as a witness before the High Court. Equally, it is provided that in the case of the person who is the subject of the inquiry his or her representative, if any, should be given an opportunity of being present at the hearing. There is no question of somebody in a hospital or in a health board writing in and saying that Nurse Mary Murphy has an incurable case of alcoholism, schizophrenia or drug addiction and should be removed. Such an allegation must be backed up and full details must be given to the person concerned.
The board have a number of options. They need not exclude the person from practising nursing. They could indicate that the person concerned is in need of treatment, or that the degree of disability is not material to the practice of nursing, which is a very important issue. I do not think that a nurse with a particular physical disability or with a degree of mental illness should, of necessity, be obliged to terminate her work as a nurse. It would be a matter of assessment by the board and the options are open to them when a case is reported to them. They may decide the degree of disability is not material, that the degree of disability is material but perhaps is amenable to remedial treatment, or the board may decide that the disability is material and is likely to remain that way. Then the board would have to make up their mind and record their decision. In a quasi-judicial sense the board will be accountable for their decision because there is the right of appeal.
The procedures to be followed are clear cut. Deputy Ormonde made a point about duplication but I do not think it holds too much merit. Without a section of this kind I do not think it would be possible to operate a register or to operate the general provisions of fitness to practise. Physical or mental disability does not prevent continuing employment but there can be a degree of disability and a dispute may arise. A nurse may wish to continue in employment but her employers may be of the view it would be entirely inappropriate that she should continue to practise as a nurse. However, they would have to be prepared to back that up and in these days of litigation if one makes a mess of a case like that one finishes up paying many tens of thousands of pounds in damages. That is why I think there is considerable protection.
The fitness to practise committee must embody their findings in a report to the board, specifying the nature of the application and the evidence laid before them. A considerable number of persons, some 29 in all, will receive full information. The fast majority will be nurses and they will get information in confidence about their colleague. They will have to make up their mind about the matter. It would be inappropriate to exclude a provision of this nature if we want to take seriously matters such as professional conduct, competence and capacity. Medical records are kept by employers in relation to their employees, whether they are public service employees, civil servants or general employees. While the understandable fears expressed by Deputies exist and will remain, we can only do our best in drafting legislation to ensure that no injustice is done.
I agree with the Minister that this is of vital importance to proper administration and I am not suggesting that the provision should be diluted. I have been on interview boards in hospitals. It is a fact that nurses' records pass from one matron to another. My concern in this area is this. Supposing a young person is accused of misconduct or unfitness to practise through physical or mental disability, they go through this procedure and are found to be not guilty, will that be deleted for all time from their record? Will there be any reference to it on their record? If an interview board is confronted with a panel of applicants, all of whom are eminently suitable, the fact that this accusation might be on one applicant's record might mean that the board will come down on the side of another applicant. I am concerned that a person might have to pay for this accusation for the rest of their lives, although they are found innocent. I realise matrons have to pass on information about any serious matter, but I am concerned that there will be no reference to any accusation on the record of a person who has been proved to be innocent. We must ensure that this accusation will never preclude them from changing their employment.
I would like to know what "professional misconduct" means. Can we have a guarantee that professional misconduct means misconduct in a nurse's professional life and not her personal life? In other words, would it be regarded as professional misconduct if a nurse became an unmarried mother or if she were co-habiting? For the purpose of this section what is "professional misconduct"? Does the Minister mean professional misconduct and not personal misconduct?
I want to take issue with the Minister. He has an amazing knack. I do not know if it is deliberate or accidental, but he appears to suggest that speakers on this side of the House do not see the need for the fitness to practise committee. Nothing could be further from the truth. Everybody on this side sees the need for such a committee. The Minister is preaching to the converted in relation to the necessity for such a committee. While we have certain reservations about particular aspects of this section, we see the need for such a committee. As I said, I do not know if it is deliberate or accidental but he gives the impression that only he is converted.
Like Deputy Mac Giolla I wanted to raise the question of what constitutes alleged professional misconduct. Must it be something which was done during the time the nurse was on duty, or could it be something outside of that — for example, drunken driving? In such a case would the nurse be investigated by the fitness to practise committee? What will decide on the code of conduct for nurses? Will that be a matter for An Bord Altranais? Will they be entitled to consider offences committed while a nurse is not on duty?
May I assure Deputy Ormonde that it was not my intention to infer that Government and Opposition are not at one in the general need for a section of this nature? Deputy Glenn asked about the prospect of a record being kept of a charge of misconduct which was subsequently rejected by the fitness to practise committee, and the prospect of it being included in a person's employment record. An assurance is specifically contained in the Bill — page 19, section 39(5) — that only where a person has been found guilty of professional misconduct or deemed to be unfit, may the record be made public, but it shall not be made public without the consent of the person unless the person has been found guilty as a result of the inquiry. This is a very definite protection.
I share the Deputy's concern about this matter because when one is employing 25,000 people there is always the 0.1 per cent of either employers or persons in the profession who still act in a malicious, unpredictable and wholly reprehensible way. You never know what will happen until you hear of a particular case and then that can destroy a person's life. We must be very careful in operating this section. An Bord Altranais have been endeavouring to draw up a general code of conduct for nurses, but at present they are not empowered to do this and they are anxious to have that authority. They will be doing very considerable work in drafting such a code in the very near future.
Deputy Mac Giolla raised the understandable but extremely difficult question of the converging of gross personal misconduct and professional misconduct. It is very difficult to draw the dividing line. I have been involved in a situation with medical practitioners. For example, a medical practitioner could be grossly irresponsible in the use of alcohol to such an extent that his professional capacity was impaired. It is difficult to know where personal misconduct begins and professional misconduct ends. This Bill is rigidly confined to the question of professional misconduct in the practice of the profession. I can assure Deputy Mac Giolla that that will be the prime intention and concern of An Bord Altranais. I can only leave it like that. I can only give this assurance to Deputies and hope that the section in the Medical Practitioners Act which has stood the test of time despite many challenges will be equally effective on the nursing side.
I will expand on the point I made earlier. If a nurse works on the wards and during the time she works on the wards she develops a physical disability which ultimately results in her being unable to continue to work on the wards, if somebody were to apply to the fitness to practise committee in respect of her fitness and she was judged solely on her competence to work on the wards, then it might be possible for them to suggest that she was not fit. In circumstances such as this she should be given permission to work in other areas in which she would be competent. I would ask that the fitness to practise committee would not decide on her fitness simply because she was not competent to work on wards when she might be eminently competent to work in other areas.
This is a very valid point. If a nurse had been involved in a serious car accident for example and she had a back which made her totally incapable of handling patients in the normal way, and which would require her removal into a tutorial position for instance, if that was denied and if her employer became obdurate and demanded a fitness decision, the fitness to practise committee can go back to the employer and seek further information as to how she was accommodated and may decide then not to proceed with the report and give her a basic protection. It is a very difficult and dangerous area and one which needs strong trade unionism and strong representation to prevent any abuse of the section. The Department of Health would be monitoring the general implementation of the section. We have set up An Bord Altranais to implement it and in consultation with the board I would be anxious to see how it works out in the first couple of years. The board would be obliged to make detailed reports as to how the section worked. I would be very distressed as would all Members of this House if there were any breaches of natural justice in this area which impinge to quite an extent on the industrial relations side.
Question put and agreed to.
SECTION 40.
On section 40, amendment No. 30 in the name of the Minister was discussed and agreed with amendment No. 17.
I move amendment No. 30:
In page 20, subsection (3) lines 35 to 45, to delete paragraph (a) and substitute the following paragraph:
(a) The High Court, on the hearing of the application, may—
(i) cancel the decision, or
(ii) declare that it was proper for the Board to make a decision under this section in relation to such person and either (as the Court may consider proper) direct the Board to erase such person's name from the register or direct that during a specified period (beginning not earlier than 7 days after the decision of the Court) registration of the person's name in the register shall not have effect, or
(iii) give such other directions to the Board as the Court thinks proper.
Amendment agreed to.
Question proposed: "That section 40, as amended, stand part of the Bill."
The nurses are concerned that the failure to pay a retention fee charged by the Board may result in their removal from the register and they are concerned that this is in the same section as removal from the register for professional misconduct. Obviously not paying the retention fee could hardly be construed as professional misconduct. The other matter in relation to the retention fee is the whole question of the notification to the nurses that they may be removed from the register for failure to pay a retention fee. Nurses working abroad on mission fields or in Third World countries feel that a period of two months may not be sufficient notice for them to receive word that their retention fee has not been paid. I would like the Minister to comment on that.
I have taken careful note of the point raised by the Deputy in relation to the time limit and I am prepared to come back on Report Stage to get an agreement on an amendment if necessary. There has to be a definite time limit of expiry but I will come back to the House on that.
This section sets out that where a person has been found by the fitness to practise committee to have been guilty of a professional misconduct or to be unfit to practise the Board may decide only two things under this section, (1) that the person be erased from the register or (2) to suspend registration for a period. I note that under the next section and the following sections there are other things that the Board can do.
Section 41 refers to attaching conditions to retention on the register. Conditions could be attached in relation to a person who is physically disabled such as that they do not do ward work as in the case mentioned by Deputy Faulkner, and so on. Why are there only two decisions a board can make in this section and why are all the possibilities not listed? Do I take it that when the Board make a decision that a person has been either found guilty of professional misconduct or found to be physically unfit to practise or mentally unfit to practise that the Board as well as being able to erase from the register or to suspend registration, can also attach conditions to their retention on the register and can do what is referred to in section 42?
The general concern of the Deputy is adequately met in the section, which says:
(7) The name of any person which has been erased from the register under this section may at any time be restored to that register by direction of the Board but not otherwise, and when a person's name is so restored to that register, the Board may attach to the restoration such conditions (including the payment of a fee not exceeding the fee which would be payable by such person for registration if he was then being registered for the first time) as the Board thinks fit.
Within the framework of that section there are adequate powers given to the board to enable them to lay down the type of conditions which may well be envisaged in this regard.
There is no provision in the section for an appeal to the board. The appeal is to the High Court. How can this section mean that a person can appeal to the board? If not, would the Minister insert something to that effect?
It is important to remember that the suspension could be for a certain period and in the restoration of the name later the board could state such conditions as they think fit. There is a very broad measure of entitlement being given to the board. I am at some loss to know how better it could be stated.
I will raise it again on Report Stage. I am puzzled as to why the board would consider this matter when there has not been an appeal to them. Perhaps the Minister could insert a phrase like, "by direction of the board on appeal".
I am anxious that the Bill should be as watertight as possible. I will get in touch with the Deputy and discuss it with him before Report Stage.
Question put and agreed to.
SECTION 41.
Amendment No. 31 was discussed with amendment No. 17.
I move amendment No. 31:
In page 22, subsection (3), lines 9 to 17, to delete paragraph (a) and substitute the following paragraph:
(a) The High Court, on the hearing of the application, may—
(i) cancel the decision, or
(ii) declare that it was proper for the Board to make a decision under this section in relation to such person and either (as the Court may consider proper) direct the Board to attach such conditions as the Court thinks fit to the retention of the name of such person in the register, or
(iii) give such other directions to the Board as the Court thinks proper.
Amendment agreed to.
I move amendment No. 32.
In page 22, subsection (3) (b), line 21, to delete "Council" and substitute "Board".
It may be presumptuous of me to think I have an amendment with which the Minister can agree without reservation. Where "Council" appears in subsection (3) the reference is to the board.
I accept the amendment. The parliamentary draftsman is grateful to the Deputy for the correction.
Amendment agreed to.
Section 41, as amended, agreed to.
SECTION 42.
Question proposed: "That section 42 stand part of the Bill".
Can the Minister define "admonish" and "censure"? What would happen to a person who was censured? Then, of course, there is a difference between admonition and censuring.
This is a new provision. Up to now all the board could do was to reprimand, which was rather old fashioned language. The board could only reprimand a nurse or strike her off the register. Henceforth the board can admonish or ensure a nurse and the board formally would have to record such admonition or censure. Whether such documentation would be made public I am not sure, but the matter would have to be put on record as an act of disapproval of the person concerned. "Censure" is stronger than admonish. Either could occur because of unbecoming behaviour.
It would be the same as erasure.
It could result in that.
Question put and agreed to.
SECTION 43.
Amendment No. 33 was discussed with amendment No. 17.
I move amendment No. 33:
In page 23, subsection (3), lines 20 to 24, to delete paragraph (a) and substitute the following paragraph:
`(a) the High Court, on the hearing of the application, may—
(i) cancel the decision, or
(ii) confirm the decision and direct the Board to erase the name of such person from the register, or
(iii) give such other directions to the Board as the Court thinks proper,".
Amendment agreed to.
Section 43, as amended, agreed to.
Section 44 agreed to.
SECTION 45.
Amendment No. 35 is consequential on amendment No. 34 and they may be taken together.
I move amendment No. 34:
In page 24, subsection (1), lines 17 and 18, after "registered in", to delete "any register maintained under this Act", and substitute "the register".
These amendments are designed to correct an error of phraseology in the subsection. In other words, the subsection as presented is incorrect because it refers to "any register maintained under the Act" instead of simply "the register." The register is defined in section 2 and that is what the amendments are intended to convey.
Amendment agreed to.
I move amendment No. 35:
In page 24, subsection (1), line 19, after "person's name in", to delete "that register", and substitute "the register".
Amendment agreed to.
Section 45, as amended, agreed to.
Section 46 agreed to.
SECTION 47.
I move amendment No. 36:
In page 24, line 33, after "Minister", to insert "and the employing authority where the person is an employee".
I am asking the Minister to accept that the employing authority would be notified of the erasure from or the restoration of the name to the register. If the nurse is employed by a hospital or a health board, either authority should be notified, particularly if the nurse has been taken off the register. I am asking for this obligation as in the case of the Minister.
When the Bill was being prepared it was my general intention that the board would notify the employers. The section does not preclude the board from notifying the employer. That is why I did not consider it necessary to build the requirement into the section.
I should like to tell Deputy O'Hanlon that I am not averse to including his amendment but we will have on Report Stage to make some provision for cases where there is no employer and where the board could not notify anybody. A doctor or a member of the public may report to the board that a nurse was practising in an unprofessional or unqualified way and she could be struck off without there being an employer to notify. The requirement of notification contained in the Deputy's amendment might be too rigorous in some instances. I will prepare an amendment for Report Stage whereby the employing authority will be notified in the event of there being an employer in existence. We can get agreement on a drafting formula.
Once the Minister accepts the principle of what we have in mind, that the employing authority be notified where such an authority exists, I accept that the wording might be changed to cover the point the Minister has made.
Amendment, by leave, withdrawn.
Section 47 agreed to.
SECTION 48.
Question proposed: "That section 48 stand part of the Bill".
The section deals with the payment of a fee but I wonder if that has been covered already in section 25. Section 48 states:
The Board shall, on the payment of a special fee to the Board by any person whose name was erased or whose registration was suspended pursuant to section 40 (1) of this Act...
Is that not covered in section 25? Is the provision not more appropriate for that section which deals with fees for all types of services?
I should like to thank the Deputy for the observation and I will consider the matter.
Question put and agreed to.
Section 49 agreed to.
SECTION 50.
Amendment No. 37, in the name of the Minister, was discussed with amendment No. 29.
I move amendment No. 37:
In page 25, line 29, to delete "£500" and to substitute "£1,000".
Amendment agreed to.
I move amendment No. 38:
In page 25, between lines 31 and 32, to insert the following subsection:
"(2) Notwithstanding the provisions of section 10 (4) of the Petty Sessions (Ireland) Act, 1851, proceedings for an offence under this section may be instituted at any time within two years from the commission of the offence."
The purpose of the amendment is to provide that proceedings for an offence under the section may be instituted within two years from the commission of the offence. The normal period prescribed by section 10(4) of the Petty Sessions (Ireland) Act, 1851, within which proceedings may be instituted in a summary manner, is six months. However, the nature of the offences under this section is such that they might not come to light within six months of commission. It is considered desirable to insert this provision to enable proceedings to be instituted up to two years after the commission of an offence.
Amendment agreed to.
Section 50, as amended, agreed to.
NEW SECTION.
I move amendment No. 39:
In page 25, to delete lines 32 to 34, and substitute the following new section:
51.—The Board shall as soon as may be after the end of each year prepare and publish a report of its proceedings under this Act during the preceding year.".
The purpose of this amendment is to remove the existing provision: "the report shall contain such particulars as the Minister may direct". I received representations from nursing interests objecting to that provision for ministerial control. I have reconsidered the matter and I agree there is no justifable reason for retaining it.
Does the amendment propose to delete the existing section?
Yes, and it will be replaced by the section proposed in the amendment.
Amendment agreed to.
New section agreed to.
SECTION 52.
I move amendment No. 39a.
In page 25, lines 38 to 40, to delete subsection (2).
Section 52 states:
(2) It shall be a function of the Board to give guidance to the nursing profession generally on all matters relating to ethical conduct and behaviour.
We believe that the subsection will interfere with the rights of hospitals as employing authorities in relation to their character and ethos and will be in conflict with what was enshrined in the Hospitals Federation and Amalgamation Act, 1961. That Act clearly protects the rights of hospitals in relation to ethical matters. Section 14 (3) of that Act states:
(3) In the exercise of its functions in relation to the co-ordination of the activities of the participating hospitals in the matter of nursing education and the conduct of negotiations in regard to such matters with An Bord Altranais, the Council shall take no action which would operate to—
(a) involve a student nurse in any arrangement for attending lectures on the ethics and psychology of nursing which do not conform to her religious beliefs, or
(b) interfere with the autonomy of a nursing school attached to any participating hospital of a particular denominational character.
Subsection (2) of that section states:
(2) The Council shall not assign any visiting medical staff to a participating hospital of a particular denominational character unless the assignment is in accord with such character save with the approval of the hospital board concerned.
That enshrines the right of a hospital in regard to ethos and character. This subsection, in conjunction with other sections in the Bill, gives the Minister extraordinary powers over the ethics of a hospital. Under section 15 he has the right to discharge the board and to appoint a person or persons to discharge all or any of the functions of the board.
Under section 54 "The Board shall carry out such functions, other than the functions assigned to it by this Act, as may be assigned to it from time to time by the Minister...". I would not suggest that the present Minister at any time would use these powers incorrectly, but this legislation presumably will carry us on well beyond the end of this century and it is possible that a Minister could give a direction on some matter of fundamental ethics to An Bord Altranais. If they refuse to carry out the Minister's directive he can discharge the whole board and appoint one person to act on his behalf who could then direct a hospital in a matter of ethics, behaviour or ethical conduct which might be against the interests of the people but, particularly, against the ethos and character of the particular hospital.
The Minister may well say that this section appears in the Medical Practitioners' Act and that there was no objection to it at that time. The big distinction that I would see between the Medical Practitioners' Act and the Bill before us is that the first deals with persons who in the main are independent contractors. Only a minority of our doctors would be employees of an employing authority. The majority are independent contractors working in general practices under the general medical services scheme or working for the voluntary hospitals. On the other hand, the vast majority of nurses would be employees of an employing agency. A very tiny minority would not be. The voluntary hospitals have always cherished their right to have their own ethical code of conduct. That was enshrined on behalf of the hospitals which are run by the minority religious group here — the Federation of Hospitals. That is enshrined in the legislation which was prepared by the then Minister in 1961. I would ask the Minister to delete this subsection.
I support Deputy O'Hanlon in his request for the deletion of this subsection. It would give unlimited power to any Minister for Health. The present Minister may have good intentions, but we do not know who his successors may be. It is our business to offer the maximum protection now. The board should have the power to stipulate the guidelines of professional conduct, but it is absolutely essential that the hospitals themselves should have the right to establish the ethical code by which they would administer the service.
There is great concern at the moment in relation to this section of the Bill. As has been pointed out, there are hospitals administering to minority groups who could be very adversely affected by having a code of conduct imposed upon them. We can safely leave it to the good sense of the people who have provided this medical service down the years, and have done an excellent job for all of us, to decide the code of conduct which best suits the milieu of their hospital.
This is also very important because of the area of medicine into which we are entering at the close of the twentieth century. Medicine is becoming something for debate in most of the Parliaments of the world, with the advent of surrogacy and so many other new technologies. It is essential that we in this country, who have had the benefit of the services of so many religious of all denominations in this area, protect their interests in the common good and for the welfare of all of us.
I am going to resists recalling my earlier contributions to the Nurses Bill when I availed of the opportunity to express my concern at this section. I am happy to have the comfort of being quite safe in repeating my concern and my reservations. It is unfortunate that in our country today, if one expresses concern which can be interpreted as the maintaining of what one regards as best in society and if it has any reference at all to religious, straight away one runs the risk of being regarded as an oddity and also of being misquoted elsewhere. I do not mind that. The Minister's concern, as expressed early on, that most of the hospitals do not have ethical guidelines is an indication that he and his Department were unhappy about the guidelines in certain hospitals. My concern was that his unhappiness should not refer to the hospitals in which I would have absolute faith and confidence. Those hospitals are largely managed by the religious. I make no apologies whatsoever for saying that, in respect of that management, the religious have displayed an interest, suitability, temperament and spirit of self-sacrifice which has left all those institutions the better for their presence, to say the very least. I hope nobody would argue with that. Instead of having that diluted, it should be maintained, and, if possible, fortified.
This Bill seems not to recognise the importance of the existing high ethical standards obtaining in these hospitals. I would not object to anybody who wants another hospital which has ethical standards different from those getting it, if it suits what is regarded as the needs of other people. I am quite safe in saying that I interpret the wish of the vast majority of our people that there should be an element existing in our hospitals today, a regard for ethical standards, which must be preserved and cherished to the betterment of all.
I would put to the House and the Deputies listening a question as to whether when we strive to accommodate in one big splash the feelings and desires of all we improve the situation. I reject any proposition that the introduction of a rule common to everybody improves anything. Rather would I say that excellence comes from the pursuit of a diversity of interests and elements which ultimately leaves a better product.
I am unhappy about the Minister's desire to introduce what he described at column 1569 of the Official Report of 5 December as "a code of ethical conduct applying across the board in the profession". I do not make any apology to the Minister who is present. I am not indicating all the faith and confidence other people have expressed in him. I am taking him at his word. I have not got the confidence in him which I would like to have. It is he who is saying this, not some future Minister. I do not think he should have this power because he is not the best interpreter of what I regard as being in the best interests of the people I represent. I would be doing the Minister and the House an injustice if I were to make any hypocritical comment of commendation of the Minister. In all honesty I could not do it. The Minister will not lose any sleep over that. I could not indulge in any complimentary remarks to him when inwardly I harbour these fears.
In the matter of health the religious have made a contribution parallel to the contribution made by the religious in our educational system. Perhaps it is fashionable to reject them and to speak about some unreasonable Christian Brother here or an unreasonable nun elsewhere and castigate the whole system. We all know they have made a very special contribution and, in at least some of our hospitals, I want the maintenance, the continuation and the development of that effort.
I do not want the idea to go abroad that we are dissatisfied or unhappy with the ethical standards obtaining in our hospitals. That is the fear I have. You do not improve anything by reducing everything to the lowest common denominator. That applies to all aspects of life and not just to health, education and matters of religious services or practices. If the Minister has available to him some proof or evidence of any weakness in what I contend, I maintain that the best product of all is that which emerges after a diversity of effort and conviction by a miscellany of people and agents and agencies. It does not come from watering down everything to the lowest common denominator.
This gives the Minister the right to remove existing ethical standards and have them replaced by others. If there are ills I would rather bear those we have than fly to others of which we know not. I will not fly to the others unless some indication is given of what they are. I ask the Minister when he is replying not to extract something from what I said as he did on another occasion when he said I was expressing concern because the religious were not being provided for. I made no such statement and the Minister knew that well. He thought he would seem to be making a better case if he could establish that I said that. As reported at column 1560 of the Official Report, I said:
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.
That was a very fair observation, a very legitimate concern. I realise I will have an opportunity to react to what the Minister may say. In the interests of democracy and the rights of people, apart from the necessity or desirability of it, I ask the Minister to have regard to the rights of people to have recourse to hospitals where they know ethical standards are operating with which they can feel comfortable. There is nothing unreasonable about that. It is unfortunate that anyone here should have to express that concern about their removal. I will leave it at that for the moment.
I am surprised that an amendment has been moved by Fianna Fáil to delete this section and by the Deputies who are supporting the deletion of the section. We have been dealing with the Nurses Bill for quite some time. Great praise was given to nurses by all speakers in the Second Stage debate and on Committee Stage. We have been saying what a wonderful band of people they are, what dedicated service they give, and so on. Now we do not trust them. This amendment says we cannot trust nurses. The whole purpose of this Bill is to raise the status of the nursing profession and we are now telling them we do not trust them as we trust doctors. It is all right for Deputy O'Hanlon to say most doctors are self-employed and most nurses are employees. There are self-employed nurses as well, although not as high a proportion as the self-employed doctors. It is easy for doctors to put a plate on their doors and settle down to business.
We have no objection to the medical profession setting their own ethical standards. No one has suggested that should be taken away from them, or that the fact that they have set their own ethical standards is interfering with the hospitals' regulations in regard to their ethical standards. We are talking now about the nursing profession and the nurses board. In spite of what Deputy Tunney said, while the Minister has power to abolish the board he has not got power to give guidance to nurses in relation to ethical conduct and behaviour. An Bord Altranais have that function under the Act.
About an hour ago we dealt with a section on professional misconduct. I am quite sure the hospitals have their own regulations in regard to misconduct. Under that section we did not contend that the nursing board should not have any authority to deal with professional misconduct in the nursing profession, that this should be left to the hospitals since they are all employees of hospitals, as Deputy Dr. O'Hanlon said. What is the point in having a board with functions and in having professional status for the nursing profession unless we trust them at least to be able to give guidance to the nursing profession generally on all matters relating to ethical conduct and behaviour? If they cannot do that then they will have no function, purpose or thrust. The deletion of this section would be degrading to the nursing profession and I hope the Minister will not yield to any pressures in this regard.
Deputy Mac Giolla has covered many of the points I wished to make. I consider this to be an important provision of the Bill. Hence I would be opposed to the amendment moved by the Fianna Fáil spokesman. It is entirely reasonable, necessary and desirable that a professional body such as An Bord Altranais should have a say in matters relating to the ethics of their members. On the extremely important matters with which they must deal on a regular basis — matters of life and death in so many circumstances, relationships with other human beings and their major responsibilities towards them — it would be a sad day if they did not have a say themselves, not a total say but one that could be modified by the views and practices in individual hospitals within the context of the whole history and practice of medicine in this country. It is desirable that they have a voice. The suspicions this provision seems to have raised are entirely unjustified and unwarranted. Subsections (1) and (3) are totally noncontroversial—
We are dealing here only with subsection (2).
In that area very soon the whole of the medical profession, indeed the political world and the whole nation will have to face up to major topics in the area of medicine which were referred to by Deputy Glenn when making a different point. We must remember all the developments in the area of genetic engineering and surrogacy which are moving at a phenomenal pace. Are we to contend that a body dealing directly with such matters should not have any say? For example, are those who have questioned this section afraid of that responsibility? It is something to which we shall all have to face up to very soon when the views and contribution of the nursing profession will be needed. Therefore, it should be allowed to have its say in how we handle these overwhelming, frightening and challenging developments in medicine. It is important therefore that this section remain.
I support the amendment submitted by our Spokesman on Health. The first thought that struck me on reading the subsection was how the word "ethical" came to be used. I could understand and accept the usage of the word "behaviour". It is not sufficient to say that the reason it is included is that it appeared in other Bills. After all, other Bills were for other times. We are dealing with present day experiences and in that light I could not understand the usage of the word.
The first question that arises is: what qualifications would the board or individual members have to lay down ethical standards or to give guidance on ethical standards to the nursing profession? I am strongly of the opinion that the word "guidance" could very quickly and easily lose its ordinary meaning in this context. One might well visualise a situation in which when the board give guidance they would expect that guidance on ethical matters to be followed and, where it was not followed, equally one could visualise the board deciding on ways and means of ensuring that it is so followed. Therefore I would say to Deputy Mac Giolla that it is not a question of our not trusting the nurses. We certainly do trust them; we have a very high regard for them. But, as I see it, there is a possibility that the board could enforce their views on the nurses and in so doing enforce a particular ethos on a hospital in which those nurses worked. It might be suggested that An Bord Altranais would not lay down standards in respect of ethical behaviour which would be at variance with the ethos of a particular hospital. Probably that would have been the situation that obtained in the past, that might even obtained at present, although in view of the pressures current in the media and elsewhere I would not be too sure of that. For the future one would need to be on one's guard.
The provisions of this subsection mean that, if An Bord Altranais so decide, they could impose their code of ethics on nurses in hospitals, which code could be in complete contradiction to the code and general ethics of such hospitals. If, as Deputy Tunney said, there are hospitals with different codes of ethics, with which I might not personally agree, they are perfectly justified in having them and I do not object to such. But we have a duty to protect the code of ethics in different hospitals which we find satisfactory. It is our duty to protect that code. For example, guidance by the board could include a proviso that, if a nurse refused to participate in a particular type of operation to which she had conscientious objections, she could be disciplined and could possibly lose her job. It should be remembered that at present there is no mobility within the nursing profession. Therefore there is no way in which a nurse can move elsewhere if she or he cannot accept a particular hospital's procedures. It is vital that there be a conscience clause included which would enable nurses to refuse to take part in matters to which they had a conscientious objection.
Anything that affects a nurse in his or her work affects the hospital in which they work. Therefore guidance by An Bord Altranais — and this could easily change from guidance to an instruction, when An Bord Altranais could insist on guidance by them being accepted by nurses — affects the ethos of the hospital in which nurses work. The Minister said earlier that there were no codes in many hospitals. The reality is that, while there may not have been written codes, there certainly were and are codes of behaviour. There always have been codes of conduct in our hospitals, though not necessarily written ones. In all of those circumstances the amendment submitted by Deputy O'Hanlon should have the support of the House.
I merely wish to reiterate and add a little to the contributions of Deputy Mac Giolla and Deputy O'Flaherty. With all due respect to Deputy Faulkner, when he was talking about the board and its impositions, he seemed to think they were from an alien planet. As Deputy Mac Giolla pointed out, the board is made up of professional people who will be given the responsibility in regard to qualifications, training and the future and status of nursing. Deputy O'Hanlon informed us that doctors were allowed to have such a clause, autonomy, responsibility and authority included and, suddenly, we decide that we cannot trust a board which is composed of nurses. I am reminded once again of the authoritarianism which pervades this Chamber again and again and that there is a male point of view evident when looking at certain sections of the community who are not considered responsible enough to be allowed authority and autonomy. If doctors are allowed to have such a clause, without any conflict or tensions between them and hospitals, it is quite outrageous that we should insult nurses by even suggesting that they would not have the responsibility, integrity or the sheer professionalism to conduct their affairs properly.
I want to deal with points made by Deputy Mac Giolla and those who reiterated what he said. He is correct in saying that we gave great praise to the nurses throughout this debate and we never deviated from that praise. Deputy Mac Giolla was here when I spoke and I am sure he heard exactly. what I said although he chooses to ignore it.
Section 15 gives the Minister power to discharge the board and section 54 gives him the power to assign new functions to the board. The board could be abolished and the Minister could then direct the person or persons acting on the board to decide on ethical standards and behaviour which would be transferred to hospitals. I am not concerned about a board that will be elected mainly from nurses because I trust them and, when the board is functioning as outlined in the Bill, I am sure they will be able to give guidance in matters relating to ethical conduct and behaviour. However, I am very concerned that some time in the future — and this Bill will probably be law well beyond the end of the century — a Minister could, under section 54, direct the nursing board on an ethical matter which may be totally unacceptable to the public and that, if the board did not agree with him, he could use section 15 to abolish it. He would then be in a position whereby the person nominated by him would give guidance on all matters relating to ethical conduct and behaviour. That is why I want this subsection deleted. If the Minister is prepared to delete sections 15 and 54 of the Bill which give these extraordinary powers to the Minister, the subsection would not have the serious implications it has, particularly when taken in conjunction with sections 15 and 54.
I do not understand the point made by Deputy Barnes because I thought that in 1985 the medical profession was seen as representing male and female points of view and that the nursing profession would also be seen as representing male and female points of view. I did not think anybody would perceive the medical profession as representing a male point of view and the nursing profession as representing a female point of view.
That is the reality at present.
I support the Members who requested the deletion of section 52(2). This section attempts to take from the hospital the right to determine their own ethical policy. Earlier on we discussed the fitness to practise committee and we all accept that the board should be in a position to give guidance on professional conduct and behaviour to each hospital. However, each hospital, particularly voluntary hospitals, should have the right to decide their own ethical code. Perhaps, as Deputy Faulkner said, we could get around this problem by including a conscience clause because each hospital, in deciding their own ethical code, would respect the conscience of each individual employee. Men and women practise the profession of nursing.
What about the College of Surgeons?
We are dealing with the Nurses Bill. I was amazed to hear Deputy Mac Giolla say that we do not trust nurses. If he really believes this, he is duty bound to support our amendment because we are trying to protect the nurses from a future Minister who, under section 54, can impose any number of conditions, ethical or otherwise, and this is what we are trying to prevent.
I am genuinely surprised that a number of Deputies still hold the view, after several months, that the board should not be empowered to give guidance to the nursing profession on matters of ethical conduct and behaviour. I am even more surprised that two members of the medical profession advocated that the ethical codes to which they adhere should not be applied to nurses——
We explained that medical practitioners are independent contractors.
Doctors are bound by the guide to ethical conduct, behaviour and fitness to practise of the Medical Council——
As independent contractors.
This also applies to the Dentists Bill which is before the House and there were no protests about the section in that Bill which contains precisely the same provision contained in the Nurses Bill. There is more than a grain of truth in what Deputy Mac Giolla said, namely, that we do not trust nurses on medical issues and that we do not want to trust women who are nurses. Forget about the Minister of the day — I do not think, in the view of Deputy Tunney, that any Minister could be worse than me; future Ministers will be political arch— angels, he need not worry about that. The Minister of the day does not have a function in relation to the determination of ethical conduct. That is a function of An Bord Altranais. Members of the board, all of whom will be elected will be from the different echelons of nursing, matrons, tutors, administrators and so on. Some will be religious, some not, some married and some not married. Some will be male and some will be female but the overwhelming membership of the board will comprise elected nurses. They will decide for the profession as a whole, in broad general terms, the code of ethical conduct and behaviour they consider to be fitting for the profession.
This is not another Barry Desmond Bill. The section provides that it shall be a function of the board to give guidance to the nursing profession generally on all matters relating to ethical conduct and behaviour but there seems to be a deep resentment in giving this function to the board. I am equally surprised that the Deputies are suggesting that the word "professional" should be left in but the word "ethical" deleted. To draw an analogy, one could procure an abortion in this country with the greatest professional competence——
The amendment proposes to delete the lot.
——but in the process the person performing the operation would be acting not only unethically but wholly illegally. This is the issue to which Deputies should address themselves. To say the least it is incongruous that members of the medical profession should be cavilling on this issue. Equally, it is incongruous that one should attempt to draw the old red herring of the code of conduct of, for example, voluntary hospitals and of nurses generally. I would have thought that that decrepit red herring had been buried with the common contract in terms of the consultants whereby we resolved, without any great difficulty the position of consultants in voluntary hospitals, people who adhere to the code of conduct laid down by the Medical Council and who simultaneously are within a framework of adherence to the code of conduct of their employer.
I was surprised that Deputy O'Hanlon raised the matter of, to use the offensive term, the minority denominations. That matter was resolved by way of the Hospitals Federation and Amalgamation Act, 1961. The relevant section provides that in the exercise of their functions in relation to the co-ordination of the activities of the participating hospitals in the matter of nursing education and the conduct of negotiations in relation to such matters with An Bord Altranais, the council should take no action which would operate to involve a student nurse in any arrangement for attending lectures on the ethics and psychology of nursing which do not accord with her religious beliefs or interfere with the autonomy of a nurses school attaching to any hospital of a particular denomination or character. That Act is still in force. It was put through by a Fianna Fáil Minister for Health so I do not know what the Deputies opposite are up to.
There was considerable reaction initially against the section. There was a reaction expressed by a spokesperson for the Conference of Major Religious Superiors in Ireland. The view was expressed that the section would remove from hospitals the right to determine their own ethical policy. I have discussed the Bill with employers, with the trade unions concerned and with the Conference of Major Religious Superiors and I have reasonably assured them that the section does not give grounds for all those horrendous predictions as to how voluntary hospitals or others will be affected. That assurance seems generally to have percolated through. It simply involves an explanation of what the section is all about. I think that those who had major misconceptions about the provisions earlier on have now realised what is involved.
Equally I would make the point that there are many thousands of nurses who are not working in a hospital situation. It is suggested, for example, that there be no code of ethics in respect of public health nurses?
They are employed by health boards.
Is it suggested that the health boards should not have the advice and guidance of An Bord Altranais in respect of the professional and ethical conduct of public health nurses? If I were on the Opposition benches I would be saying that of course the health boards should have the guidance of An Bord Altranais in these matters. Is it suggested, for example, that the 6,200 psychiatric nurses who in the main are employed by the health boards are to be excluded? All this does not add up in terms of the objections being voiced by Deputies opposite. There are private hospitals that are answerable only to themselves. Some of these are run by people in religion and some not. Are they to be exempted from this legislation? We are dealing with a national body concerned with the registration, the education and the fitness to practise of members of the nursing profession. It is through the registration process that the profession as a whole will be in a position to establish a professional identity. If we are to have that identity, we cannot judge fitness to practise and above all the board cannot fulfil their function if a total silence on this very issue is maintained. Otherwise, what would be the purpose of this professional responsibility devolving on the board?
In respect of professional matters, are the following the only issues involved: the wearing of white gloves, not advertising one's wares, the ability to distinguish between the male and female body or learning how to give a transfusion correctly? With respect to the nursing profession a far wider professional aspect should be encompassed because if An Bord Altranais are not in a position to advise nurses on matters of professional and ethical conduct, how could the board penalise them in terms of professional misconduct. Professional misconduct must be assessed and it must be assessed frequently in an ethical context just as happens in respect of members of the medical profession in terms of the Medical Council. We really should not be arguing this matter at all.
There is a code of behaviour that applies to doctors in respect of such matters as responsibility to patients, confidentiality, consent, information, responsibility to colleagues, advertising, deputising arrangements, responsibility to the community, certification, human research, donor organ procurement, euthanasia, relationship to prisoners and reproductive medicine. These are the rules for consultants working in hospitals, many of them voluntary hospitals.
On the question of professional standards, there are laid down codes of behaviour in relation to such matters as behaviour towards patients, alcohol and the health problems of doctors, irresponsible prescribing, personal relationships between doctors and patients and so on. The Medical Council have now published a second edition. Professor Patrick Meenan is the President, Dermot Gleeson is the Vice-President and the colleges at Cork, Dublin and Galway are also represented: Professor Eamonn O'Dwyer is the representative from Galway. The Royal College of Surgeons and the Royal College of Physicians are also represented. After consultation two people are appointed by the Minister, representing psychiatry and general medical practice. There are elected members similar to the nursing side. They are elected by registered medical practitioners, a substantial body of highly respectable people. The Minister also appoints four persons. That is all that is involved and I suggest that the preoccupation of Deputies about this matter is overstressed.
The section in no way interferes with the rights of a health board or a voluntary hospital as an employer to insist on a certain structure of ethical conduct within its employment framework. An Bord Altranais deals with the general situation and the employer is directly involved. There need be no conflict with the employers so far as this Bill is concerned. I have checked very carefully and it is my view that the Minister cannot use section 54 to alter the functions of the board under section 52(2).
Why not?
Because it would be a fundamental restructuring of the Bill. In my view it would require bringing in new legislation and I do not think one would succeed on that score. God knows, I have had several experiences of the High Court and the Supreme Court in the past two and a half years and not all of them have been happy experiences. I am confident that a Minister could not bring in a fundamental change in legislation of this kind without going back to the Government and bringing the matter before the Houses of the Oireachtas. On Report Stage I will give a clear indication that any question of the extension of powers will be done by way of order and the Houses of the Oireachtas will have every opportunity within 21 days if they wish to refuse to sanction a proposed ministerial action. I do not think any future Minister would be likely to give unpalatable powers to the board. The phrase used was considered very thoroughly. I consulted far and wide about the difference between ethical and professional standards and on balance it is wiser to retain the phrase. It is not a concoction of the Department of Health in the preparation of this Bill. It is one that has been there for a long time and is entirely appropriate in this case.
I accept it is entirely reasonable for a professional body to be connected with the ethics of its profession. Deputy Glenn referred to this when she spoke about the future of medicine and developments such as genetic engineering. This would lead nurses to look to their professional body for guidance on such major developments. I do not wish to sound bloody-minded about this matter. I wish to assure the House that in respect of section 54 any action will be done by order of the Minister. The House can be assured that the code will be effective.
The main purpose of the code will be to provide a reasonable framework to assist nurses in arriving at ethical decisions and to carry out their responsibilities to patients, the public and to professional colleagues. It will also help to promote the highest possible standards of professional conduct. In that regard we have to devolve that responsibility on An Bord Altranais. They are an elected body who have competent professional people and we should trust them. Basically this is all a matter of trust. I have not the slightest doubt that the board will discharge their onerous responsibilities in the most effective way.
I shall put a question to the Minister and if he answers in the affirmative I shall be quite happy. Will the Minister tell me if it will be possible in the light of this legislation for a voluntary hospital to continue the system operating now whereby, in respect of the recruitment of nurses who have satisfied the educational requirements, the hospital will be entitled to submit those nurses to an interview as to their suitability and to require of them to follow the existing ethical standards of those hospitals?
I want to be particularly careful in my reply to the Deputy. We already had a vote on the general principle of the setting up of a central applications process. Let us take the case of a nurse who emerges from that process and is being considered for appointment by a hospital that has a certain ethos. That nurse may be told by the hospital that, while appreciating that she has the general ethical guidelines of An Bord Altranais, if she wishes to have employment in the hospital there is a way that certain matters are dealt with in the hospital and if the nurse wants employment she so signs. That is the normal established practice. However, there are many employers. Attitudes may be different in regard to nurses employed in the area of mental handicap. One employer may have a different approach to another, one may be a public employer and another may be a religious employer. Conditions of employment vary within the health services because there are 25,000 people employed by many agencies. I can assure Deputies that this section does not interfere with the freedom of health agencies — and voluntary hospitals are part of those agencies — to insist that their code of ethics shall predominate in respect of employment in their hospital. That is already there in terms of the common contract for consultants.
It is a pity the Minister did not clarify that point earlier. Now the Minister is accepting that there can be a continuation of diversity as required by the management of the hospitals, but on 5 December 1984 he said at column 1568 of the Official Report.
Those observations were made in deference 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.
The Minister is now telling us that it need not be a national standard. If the Mater Hospital or the Bon Secours Hospital wish, the existing situation may continue whereby the nurses, having satisfied the educational requirements, are entitled to be interviewed as to their suitability in regard to other matters. If the Minister is telling me that that is the case I am relieved to hear it, but that is not what he has said up to now.
I do not know what the counterpart of the bishop's crozier would be, but I think it might be a ministerial axe. I refer the Minister and Deputy Mac Giolla to section 15. Deputy Mac Giolla ordinarily comes here and convinces me that he has read the Bill in its entirety, yet he accuses me of not having trust in nurses. I do not know where I said that. I was asking him to share my trust in nurses who are called religious, for what reason I do not know. I would remind Deputy Mac Giolla that under section 15 the Minister of the day may appoint a person or persons to discharge all or any of the functions of the board. The Deputy did not seem to have noted that when he was examining this legislation and I will repeat it for him.
I was here when section 15 was debated but Deputy Tunney was not.
I was listening to everything that was said.
Deputy Tunney was not here when this was debated nor apparently did he discuss it with his spokesman.
Deputy Mac Giolla seems to suggest that the Minister has no function in this legislation but he seems to be oblivious to the provisions in section 15. Perhaps the time is now opportune to remind the House and the country of what Ministers can do in respect of boards or authorities that exist. We had discussions in this House about another authority and Ministers said, "That could not arise; I have absolute faith in the board to do what is required of them by legislation". Apparently if they do not appoint the Director-General the Minister or the Government want ——
That has nothing to do with this Bill. You may make a passing reference to it.
In this legislation the Minister is giving himself the right to appoint a person or persons to discharge all or any of the functions of the board but he cannot expect the House to accept that he would not utilise these powers. I am basing this argument on the fact that in other legislation we passed where powers, which are not as strong as those given in this legislation, were given to another Minister, the second Minister has assumed those ministerial powers. I am not going to develop the other matter as the Chair fears——
I do not fear it.
This is a fair presentation of how cautious elected representatives have to be to ensure that we do not give too much power to any Minister. In section 15 the Minister has given to himself or any succeeding Minister the right to wield that ministerial axe on any board which do not dance to his tune. That is why I am not happy about giving this or any other Minister the right to establish national guidelines of ethical conduct.
I take the Minister's reassurance that I need not have any fears for the two hospitals in my area, and that the present position as regards their rights will continue as long as he is Minister. We can be on guard in respect of any succeeding Minister who might not be as magnanimous as the present Minister.
In his earlier contribution the Minister and Deputy Mac Giolla referred to trusting An Bord Altranais. When discussing section 35 I gave the Minister the benefit of the doubt although I felt he was deliberately confusing the issue. I regret to say that once again he appears to have confused the issue deliberately.
We are discussing the deletion of section 52(2) and with section 54 and section 15, the sections which give the Minister the power and the right to dispense with the board and to direct them to behave accordingly. If the Minister were prepared to delete sections 15 and 54 we would not have any problem with section 52(2). This is our problem. We have no trouble trusting An Bord Altranais but we have reservations about the present or future Ministers taking total control of An Bord Altranais and directing them to behave as he sees fit.
Section 15 has been dealt with already.
I accept that but it must be discussed with this section. If the Minister is prepared to give us this assurance we will have no problem with section 52(2).
Section 15 was amended by the Minister.
I can do nothing about section 15 at this stage and in fairness I must say that I could not consider amending it on Report Stage. I have indicated that any action by me in relation to sections 54 or 15 will be done by order and we would insist on that by an amendment on Report Stage. It would have to go before the House. I cannot do more than that.
I am not happy with the administrative side. The issue has been clouded to an extent because the Minister, and indeed Deputy Mac Giolla, have not taken account of the implications of sections 15 and 54 of the Bill. I will take the example of abortion which the Minister used as an example. If a Minister some time in the future were to say to An Bord Altranais "The norm now for all nurses is that they should assist at abortions" and if An Bord Altranais refused this as the norm, the Minister could then invoke section 15, discharge the board and appoint a person he selected who would then be in a position to carry out the functions of the board and he could give guidance to the nursing profession on all matters relating to ethical conduct and as such could direct that this would be part of a nurse's training or part of the behaviour of a nurse. That is the reality. While I accept the present Minister's assurances, we are talking about legislation that will be here for a long time. The last Nurse's Act was passed in 1950 and this could well be the legislation for the next 35 years. It is concern about what might happen with some future Minister that is the reason we would like this section deleted or to see the phenomenal powers that the Minister has under section 15 and 54 deleted.
The argument being advanced on this issue is beginning to strain the general credulity of the House, because if a Minister of the day were to decide that An Bord Altranais should now as a matter of ethical practice encompass the practice of abortion, the Minister would be obliged to put an order to that effect before the House.
Not with the implementation of section 54.
I have clearly indicated that in respect of section 54 it will be clearly amended and any change would be by way of order, and I have no doubt that it would not take 21 days for the Opposition to wake up to the fact that that order had been made. They would probably know it within four and a half seconds flat after it going down in the House and the Minister for Health of the day would then be in a real tizzy before the House. I would like to meet that Minister.
Question put: "That the words proposed to be deleted stand."
The Committee divided: Tá, 74; Níl, 62.
Tá
- Barnes, Monica.
- Barrett, Seán.
- Barry, Myra.
- Begley, Michael.
- Bell, Michael.
- Bermingham, Joe.
- Birmingham, George Martin.
- Boland, John.
- Bruton, Richard.
- Carey, Donal.
- Cluskey, Frank.
- Collins, Edward.
- Conlon, John F.
- Connaughton, Paul.
- Coogan, Fintan.
- Cooney, Patrick Mark.
- Cosgrave, Liam T.
- Cosgrave, Michael Joe.
- Coveney, Hugh.
- Creed, Donal.
- Crotty, Kieran.
- Crowley, Frank.
- D'Arcy, Michael.
- Deasy, Martin Austin.
- Desmond, Barry.
- Desmond, Eileen.
- Donnellan, John.
- Dowling, Dick.
- Doyle, Avril.
- Dukes, Alan.
- Durkan, Bernard J.
- Enright, Thomas W.
- Farrelly, John V.
- Fennell, Nuala.
- FitzGerald, Garret.
- Flaherty, Mary.
- Flanagan, Oliver J.
- Glenn, Alice.
- Griffin, Brendan.
- Hegarty, Paddy.
- Hussey, Gemma.
- Keating, Michael.
- Kelly, John.
- Kenny, Enda.
- L'Estrange, Gerry.
- McGahon, Brendan.
- McGinley, Dinny.
- Mac Giolla, Tomás.
- McLoughlin, Frank.
- Manning, Maurice.
- Mitchell, Jim.
- Molony, David.
- Moynihan, Michael.
- Naughten, Liam.
- Nealon, Ted.
- Noonan, Michael. (Limerick East)
- O'Brien, Fergus.
- O'Brien, Willie.
- O'Leary, Michael.
- O'Sullivan, Toddy.
- O'Toole, Paddy.
- Owen, Nora.
- Pattison, Séamus.
- Prendergast, Frank.
- Quinn, Ruairí.
- Ryan, John.
- Shatter, Alan.
- Sheehan, Patrick Joseph.
- Skelly, Liam.
- Spring, Dick.
- Taylor, Mervyn.
- Taylor-Quinn, Madeline.
- Timmins, Godfrey.
- Yates, Ivan.
Tellers: Tá, Deputies Barrett (
Question declared carried.
Tá
|
Ahern, Michael.Andrews, David.Aylward, Liam.Barrett, Michael.Brady, Gerard.Brady, Vincent.Brennan, Mattie.Brennan, Paudge.Brennan, Séamus.Browne, John.Burke, Raphael P.Byrne, Hugh.Byrne, Seán.Calleary, Seán.Conaghan, Hugh.Connolly, Ger.Coughlan, Cathal Seán.Cowen, Brian.Daly, Brendan.Doherty, Seán.Fahey, Francis.Fahey, Jackie.Faulkner, Pádraig.Fitzgerald, Liam Joseph.Flynn, Pádraig.Foley, Denis.Gallagher, Denis.Gallagher, Pat Cope.Geoghegan-Quinn, Máire.Harney, Mary.Hilliard, Colm.Hyland, Liam. |
Kirk, Séamus.Kitt, Michael.Lenihan, Brian.Leonard, Jimmy.Leonard, Tom.Leyden, Terry.Lyons, Denis.McCarthy, Seán.McCreevy, Charlie.McEllistrim, Tom.Molloy, Robert.Morley, P.J.Moynihan, Donal.Nolan, M.J.Noonan, Michael J. (Limerick West)O'Connell, John.O'Dea, William.O'Hanlon, Rory.O'Kennedy, Michael.O'Leary, John.Ormonde, Donal.O'Rourke, Mary.Reynolds, Albert.Treacy, Noel.Tunney, Jim.Wallace, Dan.Walsh, Joe.Walsh, Seán.Wilson, John P.Wyse, Pearse. |
Amendment declared lost.
Section 52 agreed to.
Section 53 agreed to.
SECTION 54.
Amendments Nos. 40 and 42 are related and, by agreement, may be taken together.
I move amendment No. 40:
In page 26, line 7, after "by the Minister", to insert "by order".
Amendments Nos. 40 and 42 are designed to ensure that additional functions may not be assigned to the board by the Minister of the day without the concurrence of the Houses of the Oireachtas. The Bill as at present drafted sets out the functions of the board and indicates the nature and scope of those functions. It could be claimed that to assign additional functions would be legislating without bringing the matter before the Houses of the Oireachtas. The amendments, therefore, provide that the assignment of any additional functions will be done by ministerial order which will be subject to annulment by the Houses of the Oireachtas. The parliamentary draftsman has advised that it is also necessary to give the Minister the power to amend or revoke an order made under the section.
It would be advisable if in debating the Minister's amendments my amendment, No. 41, was included. My concern is to insert the reference to the persons engaged in such practice, nursing. I am concerned that the Minister may have powers to direct those persons. Will the Minister explain what is involved?
My understanding is that the wording is standard for such a provision. It is already contained in the Medical Practitioners Act and the Dentists Bill. That is the reason it has been included here.
Amendment agreed to.
Amendment No. 41 not moved.
I move amendment No. 42:
In page 26, between lines 9 and 10, to insert the following subsections:
"(2) The Minister may amend or revoke an order made under this section, including this subsection.
(3) Every order made 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 but without prejudice to the validity of anything previously done thereunder.".
Amendment agreed to.
Section 54, as amended, agreed to.
Sections 55 to 58, inclusive, agreed to.
SECTION 59.
Amendments Nos. 43, 44, 45 and 45(a) are related and may be taken together.
I move amendment No. 43:
In page 26, subsection (1) (c), line 44, after "or a midwife" to insert "and gives such attention as part of a course of professional training".
These amendments, which are grouped as related amendments, are designed to provide clearly that the trainees described at (c) and (d) may attend a woman in child birth only as part of their training. As at present drafted there is a possibility that it could be construed that the person mentioned in these two sub paragraphs may give such attention at any time because they are medical, midwifery or nursing students.
My amendment seeks to include persons who may attend at a delivery. There is no provision in the section for the husband of a woman to attend at the delivery. Many husbands like to attend at the delivery and many wives like to have their husbands present. While the section as presented may be intended to refer to maternity hospitals it does not take account of what would happen at a domestic delivery, in a patient's home. It is important that any person assigned by the family doctor or midwife be entitled to assist at the delivery. It is common place at a home delivery that the mother, mother-in-law or a neighbour who has had a number of children attends. Such a person might prove helpful to either the medical practitioner or the midwife. Is the Minister prepared to consider accepting my amendment?
I support Deputy O'Hanlon's amendment which seeks to include the husband and allow the midwife or doctor involved in the case to bring in additional help. I feel strongly about this. In modern day living it has become the norm almost for a wife to have her husband at her bedside during a delivery. A lot of families feel strongly about this and it should be written into the Bill. I am a parent of four children, two of whom were born in America. There was no difficulty about attending the birth of those two. The fourth child was born in Waterford and I had no difficulty in attending that birth; but, unfortunately, for the birth of the third child, who was born in Dublin, even as a doctor I was debarred. It is important that a husband, medic or non-medic, be allowed at his wife's bedside.
Perhaps we might have discussions about this issue prior to Report Stage. I am not averse to the attendance of the father at childbirth. However, there is the technical issue involved in that attending a women in childbirth is legally to conduct the process of delivery and assist in the delivery of a child as a doctor or midwife would do.
Should we have this in legislation at all? I have serious doubts about legislating for it. If it is to be included on Report Stage we will have to have a particular formula of words about a right to be present. We must also consider the medical issue. It may be that the father should not be present for medical or obstetric reasons. However, I am agreeable to discuss the matter and see if an amendment can be framed for Report Stage.
I am glad that the Minister agrees with us in principle and I am prepared to go along with him. I feel strongly that it is important that we do not leave the Bill in such a position that it would not be possible for the husband to be present at the birth.
I accept that point and I shall certainly talk to the Deputy about it.
If the Minister now wants that section agreed to, we shall agree to it.
Amendment No. 43 agreed to.
I move amendment No. 44.
In page 26, subsection (1) (d), line 45, to delete "a nurse".
Amendment agreed to.
I move amendment No. 45:
In page 26, subsection 1 (d), line 45, after "obstetrics", to insert "and gives such attention as part of a course of professional training".
Amendment agreed to.
I move amendment No. 46:
In page 27, subsection (2), line 6, to delete "£500" and to insert "£1,000".
Amendment agreed to.
Amendment No. 45a not moved.
Section 59, as amended, agreed to.
Progress reported; Committee to sit again.