As indicated in the Long Title, the purpose of this Bill is to make further and better provision for the enrolment, certification, control and training of midwives, and for other purposes relating to midwives and the practice of midwifery.
A difficulty arose in connection with the provisions of the Act of 1918 for payments to the Central Midwives Board by the county and county borough councils, described in the Act as local supervising authorities. Section 13 of that Act provided that if in any year the income derived by the board from the fees paid by candidates in respect of examinations and certificates was insufficient to cover their expenses or showed a balance against the board, the board could apportion the balance between the local supervising authorities in proportion to their rateable valuations. Those authorities were required to pay the amounts apportioned within six months of the date of the receipt of the communications notifying them of the amounts or within such further period as might be agreed upon. A long period might therefore elapse before the board received money sufficient to enable them to meet a deficit shown in their accounts at the end of a year. The board desired that special provision should be made to meet this situation and to enable them to obtain funds to pay off their deficits without such long delay.
Section 13 of the Midwives Act of 1918 provided that every woman presenting herself to the Central Midwives Board for examination and certificate should pay such fee as the board, with the approval of the Privy Council, determined, but not exceeding one guinea. The functions of the Privy Council in this matter have passed to the Minister for Local Government and Public Health. When the Act of 1918 was passed the period of training for midwives was six months. Candidates for admission to the roll of midwives were required to pass only one examination. Candidates must now pass two examinations and the period of training is two years. The Central Midwives Board consider that they should now be empowered to charge a fee for each examination, and provision is being made accordingly.
Paragraph (5) of Section 5 of the Act of 1918 empowered the Central Midwives Board to remove the name of any midwife from the roll of midwives for disobeying the rules and regulations from time to time laid down under the Act by the board, or for other misconduct. The board were not given power to summon witnesses to appear before them to give evidence in any proceedings for the removal of the name of a midwife from the roll, or to require any person to produce documents for the purposes of such proceedings. It is proposed to give the board these powers, as without them they cannot effectively carry out their functions.
Paragraph (2) of Section 16 of the Act of 1918 empowered a local supervising authority to investigate charges of malpractice, negligence, or misconduct on the part of any midwife practising within their district, and should a prima facie case be established, to report the same to the Central Midwives Board. The local supervising authority were not, however, given power to suspend the midwife when they made the report to the board, and they had no means of preventing the midwife from practising even when they had reported her for a serious offence Under Section 6 (1) of the Act of 1918 the Central Midwives Board could frame rules authorising the local supervising authority to suspend midwives from practice but the power of suspension by the local supervising authority under that section was limited to the case of a midwife against whom a prosecution had been taken for a contravention of any of the provisions of the Act. It is felt that the local supervising authority should have power to suspend the midwife from practice when they have established a prima facie case against her and reported it to the board.
The Central Midwives Board also consider that they should be given power to grant certificates of competency to teach midwifery. It is desirable that they should have such power and the necessary amendment of the law is embodied in the Bill before the House.
When providing for the amendments suggested by the Central Midwives Board some difficulties arose in connection with the drafting of a new Bill to fit in with the existing Acts on account of the different terms and authorities provided for, and it was thought desirable to draft a Bill which would consolidate the provisions of the previous Acts and embody the proposed amendments.
The Bill makes no change in regard to the constitution of the Central Midwives Board. The board is to consist of 11 members, seven of whom are to be appointed by the Minister. Four of the members appointed by the Minister shall be midwives ordinarily resident within the State. They shall be selected by the Minister after consultation with representatives of nursing organisations. One at least of the remaining three members appointed by the Minister shall be a registered medical practitioner, and the other four members of the board shall be registered medical practitioners ordinarily resident within the State elected by registered medical practitioners who are also so resident. There are no changes in the provisions constituting the Central Midwives Board. These are the provisions in the 1918 Act.
Appointments and elections to the board must be made quinquennially. Members of the board who are in office when the Act comes into operation are to continue in office until the expiration of the existing quinquennial period. The Bill contains the provisions now usual in such enactments governing the meetings and proceedings of the board and the appointment and term of office of the chairman of the board.
The appointment of the office staff required by the board is also dealt with in the Bill. The board shall, subject to the consent of the Minister, appoint such and so many officers and servants as they think proper. They are given power to regulate the remuneration of their staffs and to grant retiring allowances and gratuities to officers or servants leaving their service. In Section 20, a new provision appears which enables the board to establish a contingency fund. Under the existing law the board has no power to establish a contingency fund and from time to time unforeseen contingencies arise and it was thought desirable to give the board the necessary power to establish such a fund to meet such emergencies.
The board are required to submit an annual report of their proceedings to the Minister. The accounts to be kept by the board are also provided for, and if during any year the receipts and payments of the board show a balance against the board they are required to apportion the balance between the local supervising authorities in the same manner as was done by the former board. Each local supervising authority is required to pay the amount apportioned to it, one-fourth of the amount within one month after the receipt of the notice specifying the amount assigned, and the balance within three months.
As regards the registration of midwives, the Bill requires the Central Midwives Board to maintain and publish a roll of midwives and it indicates the procedure to be followed for the purpose of ensuring that the particulars in the roll are correct. The roll kept by the former board becomes on the appointed day the roll of midwives for the new board, and registrations in the former roll become on that day the first registrations in the roll of midwives. The board are required to register in the roll every woman who applies for registration in the prescribed manner.
The registration of a woman who is not physically and mentally fit to attend women in childbirth is prohibited, and the board are empowered to require an applicant for registration to furnish evidence of physical and mental fitness.
The provisions for the removal of the name of a midwife from the roll of midwives are dealt with in Sections 25 to 28. Section 25 empowers the Central Midwives Board to remove the name of any midwife from the roll in accordance with rules to be made by them. Such rules must provide that where it is proposed to remove the name of a midwife from the roll, proceedings in that behalf must be instituted before the board and that the defendant shall have an opportunity of answering the charges made against her.
As regards the education and training of midwives, the board are empowered to make rules providing for the courses of training and examinations to be taken by candidates for registration in the roll of midwives. They may also approve of lecturers and teachers and of institutions in which courses of training may be taken and provide for the conditions of admission to examinations. The board may also hold examinations and regulate the conduct of examinations. The board are empowered to provide post-graduate courses of training and examinations for midwives and to grant certificates or diplomas to midwives taking such courses and passing such examinations. This latter power would include the power to grant certificates of competency to teach midwifery. Under Section 47 of the Bill, the board may require midwives to attend courses of instruction approved, provided or arranged by them.
The board are required to issue to every woman who becomes a midwife, or whose name is restored to the roll of midwives, a certificate certifying that she is registered in the roll of midwives.
Section 46 of the Bill deals with the calling in by a midwife of medical assistance in an emergency. Where a midwife calls in a medical practitioner, she must report the nature of the emergency to the local supervising authority, who are required to pay a fee to the practitioner requisitioned by the midwife. The amount of the fee may be recovered from the husband or other person responsible for the patient, unless the patient is eligible for medical assistance under the Public Assistance Act, 1939. No fee is payable to the medical practitioner called in if he is the medical officer of a dispensary district and the patient is a person eligible for medical assistance and resides in the dispensary district. In this matter the section differs from Section 22 of the Midwives (Ireland) Act, 1918, under which no fee could be paid to any medical practitioner called in by a midwife to attend a patient who was entitled to medical relief under the Medical Charities Act.
These are the main provisions of the Bill. I have not gone into them in much detail. It is really a machinery Bill that very largely explains itself. I think it is a good Bill, as it contains provisions necessary for the proper control of midwives in the practice of midwifery, and for maintaining the highest standards in this branch of our national health service. In the Dáil substantial amendments were made. They were not of a very important character but, as the Bill now appears before this House, it is almost as good as we could make it. If Senators feel that it can be further improved I shall be very glad indeed of their assistance, in trying to make it a better measure than it appears to me to be.
