Additional representatives will include a nurse or midwife engaged in the public health sector, a nurse or midwife engaged in the education of nurses and midwives and a nurse engaged in the care of older persons. Of these elected members at least three must be engaged in clinical practice. Further to this a director of nursing or midwifery will be appointed and also one nurse or midwife in the third level education sector will be appointed to the board. The Bill provides for the establishment of committees by the board and those committees may include some members who are not board members. This will allow the individuals with the relevant expertise and experience to be on the committees. The board will have a split term of office. That will ensure the continuity of knowledge and experience on the board.
The public needs to be assured that any person who wishes to practise as a nurse or midwife has to register with the board. The Nurses Act 1985 provided for the statutory registration of nurses and midwives. Part 6 of this new legislation is designed to develop registration further in the interest of the protection of the public. Provision is included to prohibit a person practising as a nurse or midwife if the person is not registered with the board. However, the Bill provides for the board to issue permits to nurses from another country who are in Ireland for a short period for humanitarian purposes. The Bill protects a number of titles and makes it an offence to falsely represent oneself to be a nurse or midwife. In future the Minister for Health and Children will be able to make regulations to designate and protect additional titles if it is appropriate and in the public interest.
Section 40 prohibits a person from attending a woman in childbirth for payment, unless the person is a midwife with adequate indemnity insurance or a doctor, or training to be a midwife or doctor, except in emergency situations. The board will establish and maintain three registers. The first of these, the register of nurses and midwives, will contain the names, qualifications and any other details that the board deems to be necessary of all nurses and midwives. The legislation provides for a number of divisions. There will be separate divisions for nurses and midwives to reflect the fact that these are now recognised as two distinct professions, as well as two distinct divisions for those nurses and midwives who are practising as advanced nurse practitioners or advanced midwife practitioners. At this point I should like to address an issue that was raised in the public consultation undertaken by my Department. Currently An Bord Altranais, by rules under the 1985 Act, creates a number of divisions of the current register of nurses, for example, psychiatric nurses division. It is not, nor has it ever been, my intention that this will cease under the new legislation. The new board will retain the power to create and maintain other divisions of the registers. This will ensure flexibility in the new registration process. The legislation also provides for annotation of a registration to allow for additional qualifications to be noted.
The Bill provides that the board must also establish and maintain two additional registers. The first of these is the candidate register, which will contain the names and details of all individuals who are pursuing education and training leading to first time registration. It will consist of at least two divisions — the nurse candidate division and the midwife candidate division. This will provide for registration of individuals who are undertaking education and training for first time.
The second new register is the AMP-ANP post register. This will contain the names and details of advanced nurse practitioner posts and advanced midwife practitioner posts which meet the criteria specified by the board. It will consist of at least two divisions; the advanced nurse practitioner posts and the advanced midwife practitioner posts. These advance practice posts will be service driven. Where the HSE or a service provider identifies the need for such a post and puts the necessary structures and procedures in place, an application can be made to the board to have the post registered.
I wish to draw attention to the role of the advanced nurse practitioner and the advanced midwife practitioner. These roles were developed in response to the report on the commission on nursing that recommended the adoption of an advanced practitioner model of nursing and midwifery care which would be highly skilled and tailored to meet service needs. As these nurses and midwives are working at that advanced level, it is vital to ensure that advanced nurse and midwife practitioners only practise where the necessary structures and governance procedures are in place. In addition the competencies and skills necessary to work at advanced practice differ, depending on the specific requirements of the advanced practitioner posts. To guarantee these required structures and governance, skills and competencies, registration as an advanced nurse practitioner or an advanced midwife practitioner is dependent on employment or having an offer of employment in an registered advanced practice post. This will ensure that the public is protected by guaranteeing that advanced nurse practitioners and advanced midwife practitioners are only those who meet the standards and criteria for advanced practice, and who have the skills and competencies necessary for these posts.
The creation of a modern regulatory framework for nurses and midwives demands the establishment of a comprehensive fitness to practise structure which can act quickly and appropriately and is responsive to each individual complaint. Deputies will note that the fitness to practise provisions in Parts 7 to 9, inclusive, are aligned to the provisions of the Medical Practitioners Act. Given the onerous nature of the current fitness to practise structure on all individuals involved, the Bill provides for the establishment of a preliminary proceedings committee to assess complaints prior to the board deciding on the necessity of holding a full fitness to practise inquiry. It provides for the appointment of investigators, if required, to facilitate investigations on behalf of the preliminary proceedings committee.
A mediation process or other informal means process for less serious complaints by agreement of the parties concerned is provided for. In addition, if appropriate, the complaint can be referred to a professional competence scheme. The Bill includes provision that a complainant, if appropriate, may to be referred to another body or to the HSE complaints procedure.
I have already discussed the fact that the majority of board members will not be nurses or midwives. This will also be the case in the composition of the preliminary proceedings committee and the fitness to practise committee. The board will have the power to appoint non-board members onto these committees to ensure that there is adequate relevant knowledge for each case.
I have widened the grounds for complaint. There are now nine grounds for complaint and these include professional misconduct, poor professional performance and inappropriate behaviour. This will allow the board to investigate a greater range of complaints. Both the preliminary proceedings committee and the fitness to practise committee will possess the power to change the grounds for a complaint if, following an investigation of the facts, it is deemed that the complaint was made on incorrect grounds. This will ensure that complaints will not simply be dismissed due to inappropriate or technical grounds.
In this Bill I propose to open up the fitness to practise procedures to the public. I have decided that, in line with the Medical Practitioners Act, fitness to practise inquiries for nurses and midwives will be undertaken in public. In order to allow for individual situations where this may not be appropriate, provision is included for the fitness to practise committee to hold part or all of an inquiry in private, depending on the circumstances. Any such decision must only be taken as a result of a request by a witness, including the complainant, or the nurse or midwife concerned, to hold the proceedings in private. A decision to hold proceedings in private must take into account the public interest.
The Bill provides for a nurse or midwife, following a request by the fitness to practise committee to consent to remedial action or to a censure by the board. In these situations the inquiry is considered to be completed and the board will impose the measures agreed by the nurse or midwife. It is hoped that in these circumstances the fitness to practise inquiry will be considerably shortened.
Today, Irish nurses and midwives undertake a degree-based system of education in third level institutions. The new degree programme was a vital step in the professional development of nursing and midwifery. Considerable investment in the education of nurses and midwives has taken place over the last ten years. The quality and relevance of these education and training programmes is essential to ensure highly qualified nurses and midwives. The Bill provides for the ongoing development of standards for nurse and midwifery education and the approval of such programmes.
Part 10 of the Bill details the responsibilities of the board and the Health Service Executive with regard to the education and training both of individuals undertaking education and training to become nurses and midwives and post-registration training and education. The Health Service Executive will be given specific responsibilities with regard to specialist education and training, including the promotion of the development of specialist nursing and midwifery training and undertaking appropriate workforce planning for the purpose of meeting specialist staffing and training needs.
We as legislators must learn from mistakes of the past and move to create stronger and more robust systems of accountability. This can be achieved by continuing professional development and the demonstration of skills and competencies required for practice. Ongoing professional development is of particular importance, especially where members of the public entrust their well-being to others. We cannot legislate against mistakes but we can use this new legislation before the House to put obligations on the nurse and midwife, the employer and the regulator that will develop and mould a system for the maintenance of competency that places the safety of the patient at its centre.
Part 11 of the Bill places duties on nurses, midwives, the board and employers in terms of professional competence. Registered nurses and midwives will be obliged to maintain their professional competence on an ongoing basis. The board, as regulator, will have a leadership role in ensuring that nurses and midwives comply with the new statutory requirements for them to maintain their professional competence on an ongoing basis. It will develop, establish and operate one or more schemes of competence assurance.
The Health Service Executive and other employers must facilitate the maintenance of competence. The Bill specifically identifies workplace learning opportunities as being one way to facilitate the maintenance of professional competence. Competence can be maintained in many different ways, not just by attending training courses. As Deputies are aware, in his Budget Statement 2009, the Minister for Finance set out a programme for the rationalisation of State agencies. A number of the agencies included in this programme fall under my aegis as Minister for Health and Children including the national council. In line with this decision for the rationalisation of State agencies, the dissolution of the national council is included in this legislation. The staff, assets and liabilities of the council will be transferred to the board. Deputies have been provided with an explanatory memorandum which sets out in detail the contents of this Bill. However, I will briefly outline the provisions.
Part 1 includes standard provisions relating to commencement, interpretation of terms and repeals. Part 2 relates to An Bord Altranais. Section 6 provides for the continuance in being of the board, but under its new name. Section 8 sets out the object of the board as the protection of the public in its dealings with nurses and midwives and the integrity of the practice of nursing and midwifery through the promotion of high standards.
Section 9 outlines the functions of the board and specifies that it will perform its functions in the public interest. Sections 10 and 11 provide that the Minister may confer additional functions on the board by order and that an order made must be laid before the Houses of the Oireachtas and provides for the Minister to give general policy directions to the board relating to its functions, excluding matters relating to professional conduct and ethics, complaints, inquiries and sanctions.
Section 13 outlines the board's power to make rules and details a range of matters on which it may make such rules. Sections 15 to 17 provide for the board to enter into co-operation agreements with prescribed bodies to avoid duplication of activities and to allow for conducting joint studies.
Part 3 provides for the board to prepare a statement of strategy on an annual basis. Part 4 includes provisions for the membership, committees and employees of the board.