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Seanad Éireann debate -
Thursday, 7 Jul 1949

Vol. 36 No. 17

Nurses Bill, 1949—Second Stage.

Question proposed: "That the Bill be now read a Second Time."

I will begin by trying to give Senators some idea of the necessity for this Bill. There are a number of factors in the nursing problem with which we must now grapple. On the one hand, we have the increase which will be necessary in the number of nurses employed in the various expanding public health services according as they improve in the years immediately ahead, and on the other hand there is the fact that girls to-day do not seem to find the same attraction in the nursing profession as was once traditional.

To a certain extent the emigration of nurses is also an important factor. This may occur for a variety of reasons among which the financial one is not necessarily dominant. Conditions attaching to training elsewhere may appear to be more attractive and better prospects may seem to exist for trained nurses. A considerable amount has been done by administrative action in my Department to improve the lot of nurses who primarily are the responsibility of the Department of Health, those working in the local authority services, and the matter of remuneration for both hospital nurses and outdoor nurses in the public health services has been the subject of more than one review in recent years. In the case of many of our girls who have gone abroad to take up nursing, conditions which from a distance appeared to be particularly attractive have not in effect been sufficiently good to keep many of them there. Consequently a number are now returning to this country to take up nursing posts here. The return, however, of these exiles is not of such proportion as to render less necessary the taking of far reaching action to ensure an adequate number of nurses for our expanding services.

The problem of ensuring an adequate supply of nurses must, in the main, be attacked by the body or bodies responsible for the control of professional nurses. These two bodies at the present moment are the General Nursing Council and the Central Midwives Board. The powers which these two bodies have at the moment have been reviewed in consultation with the two bodies and my Department and they are quite obviously inadequate. If we are to try to avoid the very serious crisis which may arise from a shortage of nursing personnel to meet our growing needs it would be necessary to stimulate, by special measures, the recruitment of certain categories of nurses and this cannot be done by the existing bodies. We have, therefore, to approach the matter from the most effective manner in which the profession of nurses should be organised in the future. The establishment of a unified body representative of all the interests concerned, which would have adequate powers to deal with the many problems likely to arise is regarded as the best solution, and the present Bill has been prepared for that purpose. The explanatory memorandum circulated with it indicates its main purposes and makes it unnecessary for me to repeat them in detail.

The principal provisions in the Bill are that the Central Midwives Board and the General Nursing Council should be replaced by a single body which should control both nursing and midwifery, which will in future be treated as a branch of nursing. The necessity for termination of the legal segregation of maternity nursing from other branches will be apparent when it is realised that the job of the maternity nurse is no longer so clearly defined from the general practice of nursing as it used to be. Special training in the nursing of infants is coming to be looked upon as an essential part of the equipment of a maternity nurse. I may also say, while I have the highest appreciation of the midwifery profession as it exists and the stringent but necessary discipline under which they carry on, I am also satisfied that the determination of the legal distinction will tend, if anything, to improve the status and prestige of the maternity nurse. Personnel difficulties have not so far emerged with regard to midwives but it will be realised that the need for special measures for training are needed and the board will have power to deal with the problem by contrast with the limited powers of the present governing body.

The constitution of the board will be found in the main in clauses 12 and 13 of the Bill where it is proposed that 13 members should be appointed by the Minister following consultation, in the case of nine of these 13 appointments, with the appropriate bodies, where such exist, and that ten members should be elected. With a view to implementing the proposals of the Bill as quickly as possible—and I might add on the suggestion of one of the nursing bodies—it is considered desirable to make provision for the appointment of the entire first board by the Minister. This is a proposal which for obvious reasons did not readily commend itself to me. The proposal is put forward purely for the reasons that in using it it might possibly save time.

It is considered that the regulations governing the details of the election of members of the board will need to be detailed and extensive and would, if we had to wait for them, delay the bringing into operation of the Bill if and when it is enacted. Provision is made, however, under which the first board will hold office for approximately three years only in order that the various interested bodies may have at as early a date as possible an opportunity of electing representatives to the board. Even in the case of the first board the Minister is required to consult, where feasible, representative bodies regarding nine of the 13 nominated bodies. I hope that the proposed constitution of the board will be regarded as satisfactory as it has been the intention to set up a body representative of nursing interests which would have wide powers in connection with the future control and development of the nursing profession.

The integration of the professions of nurse and maternity nurse have not been plain sailing. In this I have been aided by advice from the existing controlling bodies. I have been impressed by the case put forward for a high degree of specialised knowledge in relation to certain problems of control of maternity nursing. The existing law recognises a difference in problems of control as between midwives and State-registered nurses and the law governing midwives lays down more detailed provision for discipline than in the case of the State-registered nurse. On the one hand, because of the nature of the maternity nurse's work, and on the other by reason of the fact that her work is often of necessity less closely supervised than that of the great bulk of State-registered nurses, it is apparent that the maintenance of a distinction in the disciplinary codes and the continual utilisation of specialised knowledge in relation to problems of discipline in the field of maternity nursing will be necessary. The Bill, accordingly, makes provision for the setting up of a special maternity nurses' committee. This committee will be in a position under the Bill to deal with day to day disciplinary matters on its own initiative and it will be mandatory on the board to accept the advice of the committee on matters relating to removal from the register or the restoration to the register of names which have been removed. In other matters affecting maternity nursing it is the intention that the advice of the committee should be available to the board and provision is accordingly made in Clause 37.

Clauses 49 and 50 of the Bill will arrange for examination and training of nurses. Such arrangements must be related to rules made with the consent of the Minister. This is a considerable extension of the powers possessed by the existing body dealing with the control of the profession. I think Senators will agree that, in face of dangers of a shortage of personnel at a time when the health services are being expanded, such a power is very necessary. It is not envisaged at this stage that the body will provide a training school for hospital nurses, at least in circumstances such as they are at present or are likely to be in the foreseeable future. The new powers will make for greater flexibility in the training of nurses for the outdoor public health services. The training of the great majority of existing public health nurses has included the complete courses in general nursing and midwifery, but has not included any course specially directed to public health matters. Post-graduate courses in various aspects of nursing could also be organised under Section 50. These courses can also help to provide adequate training to fit nurses for the more responsible supervisory posts likely to arise in the future

Provision has been made in clause 53 under which the board may, on such terms and conditions as the Minister may approve, provide institutional, hostel or other accommodation for persons attending courses of training. Clause 54 of the Bill makes provision for the award of scholarships by the board under rules made with the approval of the Minister for Finance. There is no need for me to elaborate on the manner in which the powers to be conferred under this section could be utilised in the face of a shortage of personnel in any of the branches of the profession and it will be admitted that, in the face of such a shortage, it is important that suitable persons should not be debarred from training by reason of financial considerations.

A further additional power which is not immediately related to the problem of shortage of nursing personnel will be found in clause 56. This clause enables the board by rules to maintain a division of the register in respect of a profession or calling ancillary to nursing. The board will not be empowered to act under the section until the Minister makes an Order directing them to do so. The Minister's Order may require the board to appoint a committee in respect of the profession or calling. Such a committee would be appointed under clause 18 of the Bill and could include both members of the board and persons who are not members of the board, an important provision, since specialised knowledge of the particular ancillary profession would be essential for at least some members of the committee. No definite decisions have been taken as to the professions which might be allotted a division of the register in pursuance of this section but it is considered wise to include a suitable provision in the Bill for this purpose.

Finally, I shall touch briefly on the financial provisions in the Bill. It is intended that the primary source of revenue should be the examination and registration fees. In view of the additional functions proposed to be invested in the board, however, it would be impossible to rely on this source alone unless we are prepared to contemplate a position in which such fees might become so high as to defeat the very purpose of the Bill. It is proposed accordingly in clause 58 that the Minister should pay any deficit of the board out of moneys provided by the Oireachtas, and, in clause 59, that half of the amount so recouped should be apportioned by him, in proportion to the population, among the various health authorities.

The system of financial control embodied in clause 60 will ensure reasonable supervision by the Minister over the amount and purposes for which funds are required by the board. A certain amount of capital expenditure by the board will arise particularly in implementing its new powers as to training and a provision is included in the Bill under which such expenditure may be met from the Hospitals' Trust Fund.

The provisions of the Bill, if passed, will replace those of the Nurses Registration (Ireland) Act, 1919, and the provisions of the Midwives Act, 1944, so far as relates to the constitution of the Central Midwives Board and the registration of midwives. The additional powers proposed for the new board over and above those vested in the present controlling bodies are not numerous, but they are vital if we are to ensure the provision of properly trained personnel in adequate numbers for the nursing services in the coming years.

I accordingly recommend the Bill to the earnest consideration of the Seanad.

I welcome this Bill and congratulate the Minister on its introduction. I am very glad that he has introduced this Bill in the Seanad because I think this is the proper place to discuss technical questions of this sort and a place in which we may hope that the discussion will be entirely along non-Party lines. I am naturally interested in a Bill of this sort because, as a doctor, I realise the important work which the nurse does in the treatment of the doctor's patients, and I am particularly interested in a Bill of this type because, as it happens, I have had a good deal of experience of similar bodies in connection with the medical and dental professions. I have been for some 12 years a member of the General Medical Council which controls and supervises the education of doctors and the discipline of the profession. For the same time, I have been a member of the Medical Registration Council of this country, with the same functions, and, for a slightly shorter time, of the Dental Board and I am, therefore, very familiar with the difficulties that arise in connection with regulations relating to education and discipline.

This Bill, in my opinion, is a good Bill, but it is not perfect, and I propose to make certain criticisms of it. These criticisms are not made with the idea of criticising for the sake of criticising. They are made because I believe that, if the Minister were willing to accept some of the suggestions which I propose to make, the Bill could be made an even better Bill. The first point I want to draw attention to is the title of the board. Its title, as given in Section 7, is "An Bórd Altranais." I speak that with suitable diffidence. I listened to the Minister's speech and did not once detect him mentioning the name of the body as given in the Bill. He referred to it all through as "the board" and the Bill, having mentioned the name of the body, refers to all through as "the board" and never as "an bord". I suggest it would be advisable to give this body an alternative English title so that, in speaking Irish, it could be given one title and, in English, the other. If that is not done, I feel very sure that this unfortunate body will be handicapped at its birth by being referred to as the A.B.A., on the analogy of C.I.E. and a number of other such institutions. It would be better to allow those speaking in English to call the body the Nursing Board or Council—I do not mind which. This is particularly important because in one of the sections the probability of reciprocity with other countries is envisaged and it would be unfortunate if, in all correspondence, the officials of this body had to explain to those "the board" and never as "an bord". Altranais" really meant the Nursing Board.

As regards the composition of the board, I am entirely satisfied. It is to consist of 23 members, of whom 12 are to be nurses. I think it is quite right that the nurses should have the majority. In addition, there are to be six medical representatives and three persons representing education, county councils and so on, which leaves the Minister with two to play with, and it would obviously be a good thing to appoint laymen, not technically qualified but interested in nursing. My experience on the General Medical Council is that the inclusion of a small number of lay persons is entirely to the good. They are no harsher on doctors than other doctors are and, in fact, are very much more lenient.

I quite agree with the Minister's proposal to get the body to work as soon as the Bill has been passed and to make the first board entirely a nominated board. I have one slight suggestion to make. When the scheme is in full working order, the whole board will go out of office every five years and will be replaced by a new board. Normally, a considerable number of members of the old board will be reappointed, but in the interval between the appointment of the new board and the appointment of its predecessor there might have been some crises in the nursing profession which would cause a disappearance of a considerable number of the elected members. There might also be a change of Government, which would necessitate or incur a change of the nominated members—at least, those nominated by the Minister. Therefore, a new board might come into office with a very small number of experienced persons on it. I would suggest to the Minister the possibility of staggering the appointments so that the whole body would have continuity and would not largely change its composition over five years.

I confess that there are two sections of which I completely disapprove— Sections 20 and 36. Section 20 provides that the Minister may at any time by Order remove any member of the board from office, and in Section 36 there is a similar provision in regard to the maternity nurses' committee. I have not the slightest idea that the present Minister would exercise these powers unjustly, but I object strongly to the principle of giving any Minister the right to dismiss from office a member of a body such as this without being obliged to give very good reasons for doing so. I know that he would have to give the reasons, but I object to this assumption of power by any Minister—and I make these remarks entirely in an impersonal way.

In Section 23 (1) and (2) the Minister may, quite correctly, require the board to perform any function required to be performed and if the board do not comply the Minister may by Order remove from office the members of the board. In other words, this gives the Minister power to sack the whole board. Well, he is, again, not going to do that lightly or without very good reason, but we might some time in the future—I hope it will never happen, but it might—have an unreasonable Minister for Health, quite different from the present Minister for Health. He might have some reason for getting annoyed with the board. He might give them an order and the next day, before they could meet, sack the whole lot. A time limit should be imposed whereby the Minister would require them to fulfil their proper functions within a period of, say, six months or some such period.

Section 25 prescribes the refund of travelling and subsistence expenses to the members of the board. I very much regret that the Minister has not, in this section, laid down a fee to be paid to the members of the board. There is a most regrettable modern tendency— particularly, I think, in this country— to expect doctors and other professional people to serve on various committees and bodies without remuneration. A number of the people serving on a body such as this would probably be salaried officials and would not, therefore, lose anything by attending. But the ordinary practising doctor who may be members of this board will lose a considerable amount of earnings by attending meetings such as this. I belong to a number of bodies and committees—in some of which a fee is paid for attendance, in others not. It is very striking that the percentage of attendance at meetings where a fee is payable is very much higher than in the case of bodies where no fee is payable. I think the labourer is worthy of his hire and I suggest to the Minister that a fee—five guineas or even, possibly, less—should be paid to the members for each day they attend the meetings of the board. Sections 20 and 30 deal with the maternity nurses' committee. I might say here that I am in complete agreement with the Minister on the desirability of getting one body to control various types of nurses—general nurses, and so forth. There is a distinction between the two by reason of the fact that there is this special committee to look after the maternity nurses. It is subsidiary to the board itself. This is a committee of eight of whom five are to be doctors and three nurses. However, only one of these three must be a maternity nurse. I cannot regard it as being very democratic to have a controlling committee look after maternity nurses with only one member who is a maternity nurse. I believe in the trial of an accused person by his peers and, therefore, I would appeal to the Minister to increase in this committee the number of nurses and particularly of maternity nurses. I recognise the fact that the general standard of maternity nurses is not as high as the general standard of general nurses. I recognise that probably it would be a great mistake to try and give on this committee the majority of the seats to the maternity nurses but I think that one out of eight is cutting the proportion down to an unreasonable extent.

Under Section 44 (2), when it is proposed to remove the name of any person from the register the defendant shall have the opportunity of answering the allegations made against the defendant. You must realise that this board is a judicial body. It has the power of inflicting one of the heaviest possible penalties. It may remove from the register of nurses the name of a nurse accused of an offence and, in that way, deprive her of her livelihood. I feel that here the accused person is not being offered reasonable justice. I do not think that an opportunity of answering the allegations is adequate. The accused person should have the right to be present during the whole of the hearing of the case and I am certain that the accused person should have the right—as exists on the General Medical Council, the Medical Registration Council and the Dental Board—of being represented at the hearing by counsel or by a solicitor. Many of these nurses are fairly young women, some of them without very great experience of the world. Such a person is liable to be terrified when confronted by a body of 23 people who constitute the judge and the jury and she would be quite incapable of making an adequate defence in regard to the charges made. The charges likely to be brought against the nurse, I think in many cases, might be more difficult to meet than the charges likely to be made against a doctor. Another nurse —a former friend but a present enemy —might bring charges which might be very difficult to refute. I have had a good deal of experience of seeing accused doctors trying to represent themselves before the General Medical Council. They may have a very good case. They certainly have a most sympathetic body to act as judge and jury. However, in many cases they have been quite incapable of appreciating the points of law involved and of doing their own case justice. The contrast between the doctor who tries to represent himself and the doctor who is represented by a good counsel or solicitor is very marked. I think a nurse, charged before this body, would be in a much worse position to meet the charges than would a doctor who has had a better education and who has had more contact with the public. Therefore, I urge strongly on the Minister that this sub-section should be reworded to allow the nurse an opportunity of being present during the full hearing of the case and also of being legally represented.

Section 45 (1) deals with offences committed by maternity nurses. The procedure proposed is that the case would be tried by a maternity nurses' committee. The decision of the committee would be indicated to the board who must, on the recommendation of the committee, remove the name of the maternity nurse from the maternity nurses' division. Remember that on this maternity nurses' committee there may be only one maternity nurse—only one person with any practical experience of the difficulties which the maternity nurse has to face in the everyday work of her profession. She is not as well educated as the general nurse and is much less capable of answering charges made. She is not allowed, apparently, to answer the charges. I see no reference to the possibility of her appearing before the committee at all and there is no statement that she can be represented by solicitor or counsel. I urge on the Minister to give her the same rights as a general nurse and that both be given the further rights of legal representation.

Section 48 (1) says that an appeal may be either to the High Court or to the Minister, but not to both. I believe this is a fairly common form, but I fail to appreciate the point in it. If I were about to have my name removed from the register and was told I might appeal to the High Court or the Minister, I would be very doubtful as to which would have the more tender heart. I do not know how anyone could decide which would be the better. I cannot see any objection to allowing an appeal first to the Minister and then to the High Court. I believe that appeals would very rarely be made under this section.

The Minister referred to the shortage of nurses and the difficulty of providing training in this country. I thoroughly appreciate both of those difficulties. Sections 49 and 50 give the board power to provide training and under these provisions I think it could start a school of nursing. I admit that the present method of training is not satisfactory. It is not as bad as it was 20 or 30 years ago, when nurses were trained by doing the work and nurses in training were merely cheap labour for the hospital. There is still too much of that and hospitals require too much of nurses in training. We must train the nurses and not merely allow them to pick up the profession by doing the work or seeing other people do it. There must be practical work, of course, but there must be basic and theoretical training. It is difficult to provide that under our conditions in this country.

Some hospitals act as training schools, but they are not in all cases provided with the necessary departments to give complete and adequate training. Some body such as this board might materially assist in the training and I think the correct function of this board is in arranging the curriculum, dealing with examinations, with registration and with the question of discipline. I do not like the idea of a body with all this responsibility being empowered to become itself a school. The situation might arise that this body, running its own nursing school in Dublin, may be in competition with a nursing school run by a group of hospitals, say, in Cork. The board would be running a school while also arranging the curriculum and examinations both for its own students and for the students of the school in competition. I think that would be unfair and I would prefer that the Minister should not take power to operate a school. Perhaps a school is not likely to be started, but it is a possibility.

In order to give adequate training, better provision must be made and this board, helped by the sweepstake funds, might very well assist by making substantial grants to existing schools, and by persuading smaller schools to amalgamate to make one good school. I object only to the board itself operating a school. I would heartily welcome the board assisting in teaching in that way and, of course, I would have no objection to that type of assistance.

Section 56 envisages a very big scheme. It is an attempt to get under one management all varieties of nursing. General nursing and maternity nursing are dealt with in the first place. The register of nurses may be extended to ancillary professions, for example, to physiotherapists or radiologists and the board may appoint a committee to look after those interests.

That is a little vague. The board could appoint a committee of its own members to look after such particular interests and that would be entirely wrong. It should be indicated that the interest of such ancillaries should be looked after by a committee under the auspices of the board but on very similar lines to the maternity nurses' committee, a committee with representation of the specific interests involved.

I have drawn the Minister's attention and the attention of Senators to various provisions in this Bill. I do so because I regard it as an important one, a necessary one and, in the main, an exceedingly good one. I would like to see it still further improved and I trust the Minister will give consideration to the points I have raised. None of them has been raised by way of criticism, but with the intention of improving the provisions of this Bill, the introduction of which I welcome in this House.

I agree with everything that Senator Bigger has said, accepting his opinion on the technical points, about which I am not qualified to talk. I welcome this Bill for what it sets out to do. I would like to see it improved in the ways he has indicated and in other ways. The Minister points out that the shortage of nurses is likely to continue. Through this Bill it is hoped to confer on nurses a status and a recognition which they have long deserved. That, however, is not sufficient. The conditions of nursing will have to be improved. This Bill does not set out to do that, so I assume I cannot dwell on that point, except in so far as the Minister has referred to it. It is proposed in effect to give nurses a title, a badge, status and recognition. All that is necessary and desirable, but nurses want something more. As Senator Bigger has pointed out, they want a proper course of training, they want an opportunity to take that course, and they want to be certain, when they have taken up the profession, that they will not have to spend the first few years as very badly paid or completely unpaid housemaids, scrubbers, washers, hewers of wood and drawers of water. They have to pick up the professional knowledge haphazardly. Much as we all respect doctors, we may, however, escape the doctor if we are lucky, but very few of us can escape passing through the hands of the nurse at one period or another.

I have been asked by the Irish Nurses' Organisation to put forward some of their views. They would call the attention of the Minister to Section 12, in which he is authorised to appoint 13 members. Six shall be representative of the medical profession, one shall be specially experienced in educational matters, one shall be a representative of councils of counties, and one representative of councils of county boroughs. Sub-section (2) (b) states that two shall be appointed from representatives of the nurses' profession. That makes 11 out of 13. There is no direct reference to the other two. The Minister keeps them up his sleeve and he will produce them at the proper time.

Sub-section (3) of Section 2 indicates that the Minister shall consult such organisations and bodies as he considers suitable to advise him on the making of appointments under paragraph (a), but the Minister is left free, without consultation with nurses or anybody else, to nominate two members of the nursing profession under sub-section (b). The nursing organisations think they should be consulted before he appoints such representatives. The Minister will make the initial appointment of the ten nurse members under Section 2. It is assumed that these appointments will consist in the ratification for a further period of those members of the nursing profession who are at present members of the General Nursing Council and the Central Midwives' Board, who have either been elected to these bodies by the nursing profession or nominated by the Minister.

Senator Bigger referred to maternity nurses and to the special provision in the Bill for them. As he mentioned, there are two bodies dealing with the nursing profession, the General Nursing Council and the Central Midwives' Board. Some nurses consider that the new board, whether it has an Irish or an English title, will have sufficient powers to deal with nurses generally without setting up a special council to deal with maternity nursing. They say that in Part III there is a provision that the committee be consulted on general nursing. In the explanatory memorandum to the Bill it is stated that in matters of discipline particularly in maternity nursing, the problem necessitates the making of special arrangements. There does not appear to be any justification for the appointment of a special maternity nurses' committee since the Nursing Board is given authority to set up such committees as it thinks necessary. Incidentally, the General Nursing Council always had power to set up its own committees.

The new board, which is to have all the functions previously fulfilled by these two bodies, should not have less power when set up. The proposal seems to take from the principal committee certain powers and to give them to a separate committee. I do not know if that is necessary. Apparently the Minister thinks it is. Why attempt to accentuate differences in this Bill by setting up a special committee for midwives? I am merely asking the Minister for information. I am not criticising him for doing it, although some people think it is unnecessary.

Another matter concerns the training of nurses. How, when and where are nurses to be trained, particularly for post-graduate courses? Senator Bigger pointed out that it does not seem proper that a board which sets up its own schools should award certificates to its own pupils. I think most people will agree with that. If training schools are to be provided, where are the nurses to live? I do not believe that a trainee for nursing or any other profession would be able to get living accommodation in Dublin now. There is no accommodation provided for nurses. There is certainly need also for the proper provision of living accommodation for nurses when qualified. That question will come up on another occasion and it will be then tackled. Nurses' homes are essential.

One reason why girls will not remain in the nursing profession in Ireland is that, in many cases, the living accommodation in private institutions and in hospitals is not what they expected, or what they had a right to expect. Their living quarters may be over an operating theatre, over a kitchen or other part of a building, and nurses on night duty as well as day duty have to sleep in the same part of such a building. A nurse on night duty, when she goes to bed, is awakened at all hours by the ringing of bells and other noise so that the provision of nurses' homes is urgently necessary. The board may have the right to provide proper accommodation.

I think nurses will welcome this Bill. I know that the public will welcome any recognition that can be given to nurses. This is only, as it were, pinning medals on nurses' chests when they have done their work, but something more must be done for them. They must be given a higher standard of living as well as a higher status.

I welcome this Bill which is one that can be more adequately dealt with in Committee. We should all like to see the condition of members of such a noble profession —one to which the Irish people owe so much—improved in every possible way. The Minister referred to the necessity of taking immediate steps to prevent large numbers of girls, who are anxious to enter nursing, seeking to do so abroad. If we are going to ease that position we must set out to provide better conditions here for those preparing for the profession. As Senator Bigger pointed out, in the first year of training girls who enter nursing in this country find themselves, in many hospitals, I am sorry to say, in a much more unenviable position than maids. That position must be rectified if we are going to encourage our young people to enter the profession. The White Paper says that the Bill proposes the establishment of a special board which will take over the existing functions of the General Nursing Council and the Central Midwives' Board. The Minister in his previous remarks pointed out that the present position was under review and that as a result of that review we have the present Bill. Has this Bill received the approval of both of the boards that exist and are they satisfied with its provisions? Has he entered into consultation with the boards concerned and is the Bill the result of discussions and compromises if necessary? If so, there is very little we in this House could say, but if it has not come about in that way there is need for the Seanad to give it careful consideration on the Committee Stage.

I did not intend to speak on the Bill on this stage and I agree with Senator Hawkins that it would be best discussed on the Committee Stage, but listening to the speeches of Senator Professor Bigger and Senator Seamus O'Farrell I felt that there were a few points I would like to make perhaps partly to elucidate the problem facing the Minister at the moment. The Minister for Health to-day is not the Minister for Health of 20 years ago. I am glad that Senator Professor Bigger found it possible to act as godfather to the Bill —with certain reservations as to the name of the child. But after all, with a knowledge of Irish or with no knowledge of Irish, what is the difference between calling a child "Maire" or "Mary." There is one point on which I should like to take him up however. I think he was rather critical of the training of nurses in Dublin and he has given a handle to the layman for further criticism. I know the Dublin voluntary hospitals; I have foregathered with nurses in the Dublin voluntary hospitals for the past 45 years. In fact, I married one of them so I know something of their wants, wishes and general conditions. Their general conditions are not what they ought to be but they are not nearly so bad as has been stated by people speaking here. Up to ten years ago we produced the finest body of women in the world as nurses. Nurses are like doctors up to a point. You have doctors in private practice and doctors in departmental service who will get pensions. You have private nurses and departmental nurses in local government positions with pensions and these are two different categories and it is a thing that explains a good deal of the emigration of nurses. The problem facing the Minister is that there is an enormous demand for departmental nurses to carry on the work he wants them to do in connection with tuberculosis and public health, while there is emigration to England.

I have spoken for years at meetings for nurses and nurses' pensions but the point about it is that a medical student is not paid to do a six or seven year course. His father has to pay for him and he can procure only very inadequate accommodation. If a nurse wants to be a professional woman she should learn her profession unpaid. It can be made up to her by the proper payment of the nurse when she is a qualified professional lady. I did not intend to say anything like this, but with the number of nurses which has been required for departmental work during the past ten years there is a shortage of nurses now and that is the problem the Minister must try to solve. The suggestion of a school for nurses is a detail that will have to be gone into later. This is a technical Bill for the registration and control of nurses.

My contribution to the debate is not on the technical side of the question but on the financial side. I must quarrel with the Minister, as I do with most Ministers, for putting the burden on the local authority. There is a section in this Bill, Section 59, as there is in most Bills which have been introduced recently and especially by this Government asking the local authority to bear the burden and I do not see why the local authority should be asked. If the local authority fails to pay their share the Minister is empowered to stop their contributions out of any other health grant. I think it is time that members of local authorities in this House voiced a protest. This should be a State charge as local authorities have enough to meet at the present time. Particularly in recent times local authorities are asked to pay their share but this is a Bill which I believe should be a State charge and a State charge only. I think the Minister should reconsider that matter, but if he is not prepared to do so then he should be prepared to allow local authorities greater representation on the board that is being established.

At present there is only one from the county boroughs and one from the county councils and that is inadequate representation. I do not think it is fair considering they are contributors to this scheme. The Minister should reconsider that and, if the local authority has to make a contribution, give them greater representation. County councils and municipal bodies, if the Minister asked them, could nominate members who would be quite a help to him. I leave aside the matter of title and ask the Minister to reconsider the matter of the local authorities' contribution and, if he insists upon it, their better representation.

I am well aware that this is a technical Bill and I hesitate to intervene in the debate, but at the same time I would like to be one of those who say they welcome this Bill because I think it will do much to give that prestige and dignity to the nursing profession which is so long overdue to the profession to which we all owe so much, everyone of us. This Bill is one which will set up a board the standing of which will equal that of the General Medical Council in its own sphere and for that reason I think it will give the necessary prestige to the profession. I gathered from the Minister's remarks—and I am glad of it— that in drafting the Bill the various nurses' organisations had quite obviously been contacted. I feel also quite sure that if any points were still outstanding in the Bill to which they felt attention could be directed they would have taken the trouble to contact members of this House competent to put their points. Therefore I feel that there is not much a layman can say on the technical matter but there is one point I would like to make. I consider any Bill which gives professional recognition or sets up an authority that has power to give professional recognition to people who so desire it should have somewhere in its constitution the power to control the financial remuneration of the members of the profession. The control of education and examinations, financial remuneration, living conditions and general conditions of work and employment should be the function of such a board.

I feel this Bill would be greatly improved if some definite mention was made setting out that the board would advise the Minister on this question. The fact that it has been omitted from the Bill entirely suggests to me that the Minister envisages either his Department or some other organisation being responsible for the drawing up of working hours, conditions and so forth. With that point of view I would definitely disapprove. I think it has been the attitude of this Government to seek the co-operation of the people in all matters rather than to force things upon them. The Minister for Agriculture has definitely made that clear and other Ministers have expressed themselves similarly. I feel sure the Minister for Health will follow their lead. For that reason I think there would be a lot more co-operation if the Minister did these things after consultations with the people concerned and there would be more response if in dealing with matters of hours and conditions be had consultations with the bodies looking after the interests of the nurses.

As one serving on the board of two hospitals I quite realise the present position in the matter of the recruitment of staff. While I would agree with the Minister to a large extent that the medical and nursing professions are professions of vocation and the people who want to be nurses or doctors do not allow in the early stages the question of remuneration to prevent them from continuing, I do think, however, that we have to approach these things in a realistic way. A large number of our potential doctors and nurses are going to England, and this applies to nurses especially, because they are offered more attractive terms while training but that does not mean that they have not got the vocation or it is diminished in any way. If we are to be realistic we must realise that we will not attract them to our hospitals unless we can give them conditions comparable with those in England.

I think from my limited experience of boards of hospitals there are three things which must be taken into consideration and dealt with. Firstly, there is the question of salaries and remuneration. Secondly, the conditions under which nurses have to live which are often very antiquated. There is also unnecessary restriction with regard to time off, hours and general behaviour. I quite realise that in a profession where so much responsibility devolves on the individual, strict discipline is necessary in training but I do think that in many institutions there are many unnecessary and antiquated rules and regulations laid down for the nurses.

The third matter is one which I am sorry to say the Minister passed over and that is that there is a certain tendency towards lack of responsibility. What I mean by that is not so much a question of better conditions but a tendency for nurses to change from one hospital to another. This may to some extent be justified by a feeling of liking to go anywhere for a change. I find it hard to describe what I call lack of responsibility but it is there to-day. There is not that feeling of responsibility that one would like to see. That could be overcome if some responsibility were demanded from this board in maintaining a high standard of professional conduct and etiquette.

In Clauses 64 and 65 for instance the board has the responsibility to advise the Minister on various matters including research and organisation. I think such specific clause should be put in the Bill in relation to these other matters making it the board's responsibility to advise the Minister in regard to working conditions.

Otherwise I think the Bill is an excellent one which should be welcomed by everybody and which is yet another step in insuring for nursing the status in the country to which it is entitled and which has long been denied.

Like other Senators I also welcome this measure in so far as it goes to improve the status and condition of the nursing profession in this country. There can be no doubt about it that the nursing profession in this country deserves great credit for having carried on under conditions which, in many institutions, were not up to standard. I would like very much to see an improvement in the methods of training, salary, conditions and in living conditions for these nurses as quickly as possible. That applies to our local authorities and to other institutions, including voluntary hospitals, as well, of course, as the institutions dealing with the training of nurses.

I think the gratitude of this House is due to Senator Bigger for the able way he has gone into this measure. He is able to cope with it because he has a technical knowledge of these matters. I think the matters raised by him are deserving of earnest consideration by the Minister and of examination by his Department. I hope that early steps will be taken in the regulation of conditions of training, questions of salary and housing accommodation for nurses. I am inclined to think, and I agree with those who have said, that the discipline for discipline's sake in institutions where student nurses are trained is one of the reasons for the lack of student nurses. When the British became aware of a shortage of student nurses, they took steps, in their own interests, to make conditions for student nurses as attractive as possible in the hope of attracting the best of our female population into their nursing service. I am afraid that we were a little behind in seeing that, and the result was that many nurses who should have been trained and employed in this country went across to Britain. The position here now is that there is a shortage of nurses. I hope that, in preparing this Bill, the Minister had consultations with the different organisations interested in the nursing profession and if there is any further need for co-operation and, as Senator Hawkins said, for compromise, on certain issues, I hope the Minister will be prepared to agree, because I know he is sympathetic to the nursing profession. Nurses are a group of people who have given very good service, for which they are badly paid and they have to work hours and in conditions which some of my trade union friends would not be prepared to support.

With regard to general nursing homes, I understand that although there is an onus on maternity-homes to employ qualified staff, in the case of general nursing homes, whether run as private businesses by doctors or as adjuncts to hosptials, there is no such onus. I should like to know if there is anything in this Bill to ensure that that position will be remedied, as I am sure the Minister will agree that such a position is not desirable. I am not a technician and I leave the analysis of this measure to Senator Bigger and the others who have spoken with more expert knowledge than I have, but I raise that specific matter. I understand further that the nursing organisations are prepared to make representations on that issue and I should like to know if the Minister has had representations and whether, in his opinion, the Bill gives adequate power to the newly constituted board to deal with it.

Senator Bigger referred to the board to be set up to control midwives. My interpretation of it was that it might be possible to have, as members of that committee, midwives who were also general trained nurses, because it is a fact that many of our State registered nurses are also certified midwives and perhaps Senator Bigger's fears might be met along those lines.

With regard to the contribution by local authorities, there may be local authorities with a high taxable capacity to whom a small further demand on their resources would not mean very much, but there are others, such as that in County Leitrim, the taxable capacity of which is so low that representatives from the area have to be very careful about any piece of legislation which might add still further to the burden. It may be quite necessary and desirable as a general principle, but, coming from County Leitrim, I must look very carefully at every piece of legislation which may add to the burden. I do not know the extent to which this provision would apply and I have not the haziest idea of what demands may be made on a local authority under Section 59. In County Meath, a penny in the £ realises £2,400, whereas, in County Leitrim, a penny in the £ realises only £600, and because I know the uneconomic position, from a rating point of view, of my county, every time proposals for legislation come before us which are likely to add even another little straw to the load on the camel's back, I must raise the issue, as I did yesterday in the case of the Works Bill.

I am very anxious to hear from the Minister his views on the matter of the general nursing homes and whether the Bill gives power to the new board to make inspections to see if such institutions are being conducted on desirable lines and if the conditions of employment and housing of the staff are such as constitute a proper recognition of the nursing profession.

All Senators, on whichever side they sit, must have felt a movement of satisfaction and no little pride when they were given the honour to inaugurate a Bill with the title of this we hold in our hands: Nurses Bill, 1949. That satisfaction and that pride have been increased and the Minister's experiment, if I may call it so, has been justified by the excellent speech with which Senator Bigger opened this debate. It showed the Seanad in its proper light as a body qualified by experience and training to advise the Minister on points embodied in Bills. I think that never has that capacity been more clearly indicated than by Senator Bigger to-day. We all know perhaps from our own experience or contacts, the deep debt we owe to our Irish nurses; and some of us think that the most significant contribution to civilisation the latter part of the 19th century brought was when girls of education and refinement, with heroic self-abnegation submitted themselves to a rigorous training and a life of great labour and no little hardship, with small pecuniary rewards, to bring alleviation to the sick and the dying, either in hospital wards or private families.

It is only a little over a century since Charles Dickens wrote his Martin Chuzzlewit in which he drew a picture —caricatured and exaggerated, it is true—of the professional nurse of the period. Sarah Gamp may have been a caricature but she was, one believes, from an existing model and it is well to remember her and the sick rooms and death-beds over which she presided and then think with gratitude of how sickness has been robbed of its sordidness and death of many of its terrors by the splendid girls, our Irish nurses, who have made the profession what it is to-day. The position in which the nursing profession in Ireland has been placed as a result of the labours of our nurses, has received recognition from everybody and to-day eloquently from Senator Barniville.

Unfortunately, though we have proclaimed our admiration for our nurses and acknowledged the debt we owe them, we have done little to show our gratitude in a practical way. And by that I mean adequate salaries, comfortable living conditions, reasonable hours of service, without excessive night duty, and the provision of pensions. A nurse's life, even in the best conditions, is hard and exacting; the demands made on her strength and energy and nerves are so great that her working years cannot be prolonged; and yet many nurses, if they have to give up the practice of their profession, say in the "fifties", must wait until they reach the age of 70 for our social services to do anything for them, and it is impossible for them to save enough out of their meagre salaries to make provision for themselves. Many of us have been saying that this state of affairs should be ended and when I first heard of the Nurses Bill I thought its objective might be in that direction. But instead of that—if I may say so, we asked for bread and while we were not given a stone we were given something as hard —a board—a new governing body. This Bill, I suppose, might be called a Machinery Bill, and we may grant it was the first step, perhaps, towards putting the profession on a proper basis. A new board is to take over the existing functions of the General Nursing Council and the Central Midwives' Board. Let us hope that the new board will interpret the duties and powers this Bill gives them as extending to a definite endeavour to remedy the nurses' grievances and to make the conditions of their life of service in some way commensurate with what they have deserved from the people they serve.

In this hope we welcome the board and we should like them to enter on their duties with the recognition of the direction in which they have to work. I ask for information with regard to the personnel of the board—the different qualifications of the persons designated in the articles dealing with it. I do not know enough to make an informed criticism, but I missed two classes, and perhaps the Minister will not object to my pointing out what I consider a serious omission so that he may recitfy it.

We have left out a very important thing and one in which the Minister himself is particularly interested—the matter of tuberculosis. I think there should be somebody who is really very well qualified and who has made a particular study of tuberculosis on this board. I think too there should not be omitted representatives of the great Irish religious communities to whom we owe our world famous voluntary hospitals such as St. Vincent's, the Mater Misericordiæ, Jervis Street and others. Let us remember with pride that while "Sarah Gamp" and her sisters were alleviating sickness in London, Mary Aikenhead in Dublin was planning St. Vincent's and the daughters of Catherine Macauley were preparing themselves for their work in the Mater. Surely these facts should be remembered and their recognition should inspire the decision to give the religious congregations who have played such a notable part in the history of nursing in Ireland representation on this board. Their experience would be extremely useful. I think it is just a mere oversight on the part of the Minister that no mention of the categories which I have named was made in the sections dealing with the constitution of the board.

It has been pointed out that, in regard to this very important and very interesting Bill, the material will largely fall into Committee Stage work—it being of a consideraby technical nature. Therefore, I do not propose to avail now to refer to matters which, I think, I might very much more effectively put before the House in Committee. However, I desire to bring out this point at this stage. The construction and implementation of this board will be done, I am sure, very well with the assistance of an admirable Minister, a well-enlightened House and a general body of good feeling throughout the country. But these things will count for very little unless we can find the nurses. In other words, this Bill is entitled an "Act to make further and better provision for the registration..." If we could, at the same time, see in what way we are going to get more nurses I would feel much easier in my mind in considering the technical details on the Committee Stage of this Bill.

There are three reasons for this appalling famine—reasons which the Minister and many Senators know perfectly well. In the last 25 or 30 years, we have had a series of revolutions and in no departments of human activity has the revolution been greater than in medicine. It has altered even since my medical student days, partly because of the tremendous improvement in personal and social hygiene, and partly because the expectation of life has increased and infant mortality has been reduced. We are a healthier population but that has been done at a very increased cost of medical services. As a result, we are in a particularly paradoxical position that the healthier a nation we become the more we have to spend on health services. I wonder what the Minister thinks is the correct number of nurses we require. We can calculate the number of maternity nurses needed from the birth rate but not for the others. One reason is that the need is increasing daily. The ordinary nursing profession is being steadily expanded by a vast army of auxiliaries—we have dieticians, radiographers, pediatricians, and so on. Not only have we to obtain a sufficient supply of nurses, but we must make provision for an increasing supply. On that technical aspect of the position of the board, we must devote a lot of attention to decide where the nursing profession is going to cease and the auxiliary to begin.

Our second difficulty is that we are already changing the type of the profession. Some other Senators have touched on the achievements of Mrs. Gamp. The status has steadily risen and now she is attaining a position practically parallel to that of the doctor—that of a professional person, very carefully trained and chosen, selected and examined—and we are really improving her professional status. Therefore, we are making it more difficult for certain people to attain that degree. We are calling for more nurses and at the same time we are making the standard higher—and those two things will have to be equated.

The third reason is the counter-attraction of other occupations. I cannot believe that it is entirely a matter of remuneration. There is a lot in what speakers have said about the profession being a vocation as well. Many girls want to nurse sick people-it is in their nature—and we are counting on that to provide a certain percentage of the nurses. There is, however, a counter-attraction. It is a peculiar paradox that we turn to the Hospitals' Trust for support for the hospitals while at the same time I see the Hospitals' Trust releasing from employment daily an enormous number of very charming ladies, very agreeable girls and none of them over 21. I am sure that very many of them would be in the nursing profession but for this very counter-attraction.

I should be very interested to hear how the Minister proposes to make a drive for more nurses for the profession. It is somebody's job to see that it is done, though that may not come under this Bill. We will need some campaign to make people realise that this is a very attractive profession for those who like it, a very important profession for those with a sense of responsibility, and a very worthwhile profession for all our citizens, a profession that those of us trying to support the venture will try to make more attractive in the future.

I welcome the Bill and am very glad that it has been initiated in this House, as we can survey it from this angle, which I believe means a very valuable contribution.

Like Senator Bigger, I deprecate three or four things in the details, such as the Minister's retention of power to pick out someone from the board and remove him. It is hard for a member of the board to work if he feels that a hand may come down from the sky and take him away. However, let us leave that for another occasion.

Ar an gcéad dul síos, tá mé sásta leis an bprion, sabal atá i gceist anseo, an prionsabal go ndéanfaí réiteach níos fearr i gcóir banaltraí. Ag an am gcéanna, níl mé ró-shásta leis an bprionsabal a leithéid seo de Bhille a thabhairt isteach sa Seanad an chéad uair. Thuigfinn, ar ócáid, nár mhiste Bille a thúsú sa Seanad, Bille nach mbeadh i gceist ach códáil, mar a bhí i gceist aréir againn. Ach Bille dá leithéid seo, an áit a mbeadh airgead i gceist, is dóigh liom gur i nDáil Éireann ba cheart é a thúsú. Nuair a bhí Coiste na bPribhléidí ar siúl, labhair mé níos mó ná uair amháin i gcoinne an tSeanaid féin a bheith ag iarraidh Alt a chur isteach i mBille d'údródh cánacha nua a ghearradh. Níl aon athrú intinne orm i dtaobh an obair sin. Is é an ceart atá againn, do réir an Bhunreachta, ach sílim gurb é an tuisgint is coitianta atá ann gurb é dualgas an tSeanaid léirmheas a dhéanamh ar Bhillí a ritear sa Dáil agus an Dáil a chomhairliú i bpointí áirithe. Ní ceart dúinn am a chaitheamh amú. Níl fhios agam an ciallmhar dúinn ár gcuid ama a chaitheamh ag scrúdú Bille go mion, nuair chaithfidh sé dul go dtí Dáil Éireann agus, tar éis a phlé ansin, teacht ar ais chugainn. Bíodh sin mar atá, tá an Bille seo ós ár gcomhair anois agus caithfidh mé é a phlé.

Bhí mé ana-shásta le dhá óráid a tugadh anseo tráthnóna—óráidí an tSeanadóra Bigger agus an tSeanadóra Bean Uí Choincheannain. Dá mba rún a bheadh ós ar gcomhair, déarfainn go mba leor an dá óráid sin agus an cheist a shocrú ansin. Sa chéad dul síos, níl mé an-chruinn i dtaobh cuid de na pointí a lua an tAire le linn dó bheith ag caint. Níl fhios agam nár dhúirt sé nach raibh tóir ag cailíní ar bhanaltracht—"girls do not find nursing attractive." Níl fhios agam an fíor é sin, ach ní féidir liom a rá nach fíor é. Is fíor gur iomdha cailín a tháinig chugam ag fiafraí dhíom an rachadh sí isteach in ospidéal éigin ag foghlaim banaltrachta. Go minic, labhrann tuismitheoirí liom i dtaobh deis fháil a gclann iníon dul isteach ar bhanaltracht. An amhlaidh ar fud na tíre nach féidir do na h-ospidéil a ndóthain iarrthóirí fháil le dul isteach i gcóir tréineála? Más amhlaidh atá, cuireann sé ionadh orm. Labhair an tAire ar na daoine a théas thar sáile—"conditions abroad seem to be attractive." Is minic a dúramar féin, sna blianta atá caite, i dtaobh daoine a bhí ag imeacht thar sáile, nach raibh ann ach gur dóigh dóibh go mba fhearr an saol thar sáile. Is minic a scrúdaíomar an scéal agus a dúirt go mba fhearr, sa deire, do na daoine fanacht sa mbaile. Cén uair a fuair an tAire féin amach nach bhfuil ann ach gur dóigh dóibh gur fearr na coinníollacha fostaíochta i gcéin ná mar atá siad anseo? Feicim go bhfuil níos mó ná inconsistency amháin san óráid a thug sé dúinn.

Dúirt sé go bhfuil faoi roint daoine, banaltraí atá thar sáile, a mhealladh ar ais. Dúirt sé nach bhfuil dóthain díobh ag filleadh ar ais le go líonfaí na postanna atá le líonadh sa tír. Bhfuil aon rud bun os cionn leis na tuairmí a nochtaigh sé? Tá cuid acu ag filleadh, ach níl an oiread ag filleadh agus a d'fheilfeadh le go mbeadh dóthain daoine againn le haghaidh na bpostanna atá le líonadh. Bhfuil aon rud déanta aige, ó tháinig sé i gcumhacht, le cur in a luí orthu an difríocht mhór idir an tseirbhís anseo agus an tseirbhís thall?

Rinneadh caint an-mhór anseo i dtaobh an prestige a bhéarfas an Bille do bhanaltraí. Ní fheicim go ndéanann an Bille seo mórán athrú—morán thar a bhí go dtí seo. Beidh againn aon bhord amháin in ionad an dá bhord— an Bórd Altranais in ionad an dá bhord a bhí i bhfeidhm go dtí seo. Bhéarfaimid "banaltraí" ar na daoine i gcónaí; déanfaidh síad an obair chéanna agus atá siad a dhéanamh anois. Chomh fada is a bhaineann leis an mBille seo, cá bhfuil an t-athrú i dtaobh prestige? Aontaím leis an tagairt a rinne an Seanadóir Bean Uí Choincheannain, nuair a dúirt sí go dteastaíonn go géar go ndéanfaí níos mó ar shon na mbanaltraí ná iad a mholadh nó plámás a dhéanamh leo. Muna féidir leis an Aire níos mó eolais a thabhairt dúinn i dtaobh an bheartais atá leagtha amach le feabhas a chur ar an mbanaltracht, ní fheicim cén tairbhe mhór atá sa mBille seo.

Caintíodh ar thréineáil. Ba mhaith liom a fhios a bheith agam céard tá ar intinn ag an Aire mar chúram speisialta, mar ghnó speisialta don bhord seo. Cuireadh an cheist sin air ag Seanadóirí eile freisin. An bhfuil ar intinn aige go sealbhódh an bord seo scoileanna tréineála? Tá na hospidéil lán cheana féin. Níl mórán slí chun breis duine a thabhairt isteach. Na tithe cónaithe atá ann le haghaidh banaltraí, atá tógtha le hais na n-ospidéal, tá siad lán. An mbeidh scoil speisialta tréineála ag an mbord seo? An mbeidh óstán speisialta cónaithe ag an mbord seo? Cén bealach speisialta atá leagtha amach le tréineáil dóibh, thar mar tugtar dóibh faoi láthair? Cuirim i gcás na banaltraí atá ag tréineáil i nGaillimh. Tá ospidéal mhór ansin againn agus dochtuírí ana-chlúiteacha againn ag stiúradh ann. Faghann na banaltraí tréineáil phraicticiúil ins na hospidéil. Ní amháin é sin, ach—muna bhfuil deire curtha leis le gairid—tógtar isteach go dtí an Ollscoil iad agus faghann siad roint léachtaí ann. Cinnte, ní féidir léachtaí mar sin bheith le fáil ar fud na tíre. B'fhéidir go bhféadfaí na daoine sin a thabhairt go dtí cathracha ollscoile.

Business suspended at 6 p.m. and resumed at 7 p.m.

Is dóigh liom gurb é an rúd a bhí mé a rá nuair a d'éiríomar as roimh ám scoir go mba mhaith liom fios a bheith agam céard atá beartaithe ag an Aire i dtaobh cursaí tréanála banaltran thar mar atá ann faoi láthair. Ceann de na fáthanna atá agam an cheist a chur air go dtugaim faoi ndeara go bhfuil réiteach déanta sa mBille airgead d'íoc leis an mbord nua as an bPríomhchiste Stáit. Tá cumhacht faoin mBille údarás a thabhairt don bhord nua airgead d'fháil ar iasacht. Céard atá ar intinn ag an Aire i dtaobh na hiasachta agus céard le n-aghaidh a tabharfar iasacht don bhord nua as an chiste Stáit? Feicim go mbeidh sé d'údarás ag an mbord nua scoláireachtaí a thabhairt. Sílim gur féidir faoi láthair scoláireachtaí a chur ar fáil i gcásanna áirithe. Maidir leis an taobh sin den scéal níl aon rud eile le rá agam ach amháin go mba mhaith liom cúntas d'fháil faoi céard tá ar intinn ag an Aire. Céard a bheas ar bun ag an mbord nua thar mar atá ar bun go dtí seo? Ní gádh a rá linn cén chaoi a shocrós an bord nua cé ligfear isteach i ngairm na banaltrachta agus cén chaoi a mbrisfear daoine as an mbanaltracht. Séard ba mhaith linn—séard ba mhaith liomsa go háirithe—fios d'fháil air céard atá an bord nua ag dul a dhéanamh ar son na mbanaltran, agus, muna mbeidh cumhacht ag an mbord nua rudaí a dhéanamh do na banaltraí, cén beartas atá ag an Aire féin rudaí a dhéanamh ar a son. Dúirt mé anois beag comh sásta a bhí mé leis an méid a dúirt an Seanadóir Coincheannain. Tá sé fíor gur beag duine sa saol seo is mó a dteastaíonn foighid uaidh ná banaltra agus is beag dream gur mó a ngoileann oireasba foighde orthu ná na daoine a bhíonn ag plé le gairm na banaltrachta. Saol cruaidh atá acu agus ba cheart dúinn iad a chúiteamh. Ó tharla gur saol cruaidh a bhíos acu ba cheart dúinn cúiteamh dá réir sin a thabhairt dóibh ar son a gcuid seirbhíse. Ní hé amháin gur cheart dúinn iad a chúiteamh nuair atá siad ag obair ach ba cheart dúinn iad a chúiteamh nuair a éiríos siad as an obair.

Níor innis an tAire dhúinn—níor shásaigh sé mise ar aon nós—maidir leis an trioblóid atá ann daoine óga a mhealladh isteach sa ngairm. Rinneadh caint ar an smacht nó "discipline." An é sin an rud atá ag cur as do na daoine óga? Níl fhíos agam ach creidim an méid seo: má tá banaltraí maithe le bheith againn ní foláir smacht agus dian-smacht a bheith orthu le linn dóibh a bheith dá dtréanáil. Tá sé thar a bheith riachtanach go mbeadh dochtúirí i láthair agus réidh obair a dhéanamh uair ar bith atá siad ag teastáil agus tá sé chómh thábhachtach go mbeidh banaltraí i láthair agus réidh nuair is gá. An t-aon tslí a chuirfeas tú tábhacht na hoibre in a luí ar dhaoine óga smacht agus dian-smacht a bheith orthu le linn tréanála. Más amhlaidh go gcaithimid dian-smacht a chur orthu le linn tréanála caithimíd féachaint chuige go bhfuighfidh siad cúiteamh dá réir sin! e linn dóibh a bheith ag tréanáil. Tá sé fíor i leith na bpríomh-ospidéal sa tír má tá daoine óga ag cur isteach ar ghairm na banaltrachta go gcaithfidh siad táille mór a chur síos. Níl fhios agam cé mhéad, ach sílim go mbíonn suas le £100 le cur síos acu sul a ligfear isteach iad i gcóir tréanála. Thairis sin ní mór dhóibh airgead a chaitheamh ar éadaí agus le linn tréanála dóibh ní mór dóibh oibriú go han-dian agus go minic gan aon tuarastail nó íocaíocht gur fiú trácht air an fhaid atá siad ag tréanáil. An mbeidh cead ag an mbord nua ceisteanna mar sin a scrúdú, moltaí a dhéanamh agus na moltaí sin a chur i bhfeidhm? Déarfaidh an tAire gur ceist í sin a caithfear a réiteadh i slí éicint eile. Is freagra é sin ach ní freagra sásúil é. Ach má deir sé go bhfuil beartas eile déanta aige i dtaobh an scéil beidh mé sásta agus beidh muid ar fad sásta.

Ó thárla go mbeidh airgead le fáil ag an mbord nua ón Aire Airgeadais, an amhlaidh go mbeidh imeachta an bhoird faoi dhíos póireacht san Oireachtas uair ar bith a ceapfar gur gá sin? Feictear dom, más rud é go mbeidh fáil aige ar airgead an Stáit, go gcaithfidh imeachta an bhoird a theacht faoi dhíospóireacht an Oireachtas am ar bith a cheapfas lucht an Oireachtais gur cheart é a dhéanamh. Níl fhios agam an maith an rud é imeachta boird mar sin a bheith faoi dhíospóireacht phoiblí, ach ó thárla go mbeidh airgead le fáil acu ón Stáit an amhlaidh a chuirfeas siad tuarascbháil isteach ar a n-imeachta gach bliain? Feicim in Alt 64 gur féidir tuarascáil d'fháil ón mbord nua, ach an mbeidh tuarascáil bhliantúil dá cur isteach ag an mbord i dtaobh a gcuid imeachta? An mbeidh tuarascáil chomh maith le cuntais agus imeachta eile an bhoird á leagan ar bhord an Oireachtais? Sílim go bhfuil glacaithe mar phrionsabal i gcúrsaí dlí anseo nuair a bhíonn airgead le fáil ón gciste poiblí ag bord mar an bord seo gur cheart tuarascáil bhliaintiúil a chur isteach agus go mbeadh sé le fáil ag muintir an Oireachtais. Níl locht le fáil ar an mBille chomh fada is a théann sé. Má tá locht ann baineann sé leis na rudaí nach bhfuil sa mBille go mba mhaith linn a bheith sa mBille, agus má deireann an tAire linn go mbeidh slí eile aige teacht suas leis na rudaí sin beimid ar fad sásta.

I do not intend to go into any analysis of the various sections of this Bill or their implication. That ground has been adequately covered by Senators competent to express an opinion on it and to discuss its good or defective points in detail. My interest is concerned with the shortage of nurses and with the desire to find a remedy for that shortage. The present unsatisfactory position is accounted for as being caused by the small remuneration paid to nurses after they are trained. In my opinion, a far greater cause for denying to that profession the addition of excellent material is the cost involved in training a nurse. I am credibly informed by some parents, whose children had successfully completed their secondary education, and who had a desire to enter the nursing profession, that they would have to spend from £400 to £500 before they could secure training for their daughters. The peculiar position is that advertisements appear in the newspapers almost daily inviting applications from Irish girls for positions in English hospitals to which they can go—and are going—as probationers. They are offered salaries while being trained and given allowances in England which are far in excess of what they would earn as trained nurses in Ireland. That is an aspect of the situation that I should like the Minister to consider. I believe that if some provision could be made regarding the matters I refer to, excellent material could be got to implement the nursing service.

I should like to congratulate the Minister for bringing in this Bill, which was long overdue. It has been admitted on all sides for a number of years that our nurses have far too few privileges. I am glad that a stage has been reached when there is to be some improvement in their position. Take the position of a girl who has secured the leaving certificate and who wishes to be trained at one of the hospitals. The parents in one case that I know found that the entrance fee would be 100 guineas, plus the expense of uniform, as well as medical examination and other items, that would make the amount £150. The probationer would also have to work for 12 months for nothing, after which she would get a litle pocket money.

On the other hand, if that girl answered some of the advertisements that appear in the newspapers she would find that she could go to England, that her fare would be paid, uniform provided and be given a salary. That makes a big difference in a home where whatever money there was to spare was, probably, spent on the girl's education. Entrance to some of the big hospitals in Ireland is in that way made impossible, and there is no alternative but for girls to emigrate. I do not know if there is any provision in the Bill which could deal with that aspect. Unless a subsidy or something like that is provided by the Government I am afraid the numbers entering the profession in Ireland will be less and that the position may become parlous. I congratulate the Minister on bringing in this long overdue Bill.

I wish to refer to one point only, a point which affects university graduates. It has been very ably dealt with by Senator Bigger, but I feel so strongly on it on general grounds that I wish to draw the Minister's attention to it for the second time in this debate. No provision has been made in the Bill for the payment of the members of the Nursing Board. I cannot help feeling that the time has come when professional people and particularly academic people should be paid for services of this kind. There is provision under Section 25 of the Bill for the payment of expenses, but that only benefits certain people. I have served on commissions, some of which lasted over a number of years, in which the provision was that the members who came from the country got expenses which entitled them to first-class railway fare and substantial subsistence allowances while in Dublin, but we who lived in Dublin got no expenses. Nothing was allowed to us although we actually had to pay people to carry on our professional work so that we could give our time to the work of the commission. I do not think that these payments of expenses meet the case. I think the time has come when professional men and particularly academic people should not be asked to do this work without some adequate remuneration. These commissions, the Banking Commission, the Vocational Organisation Commission and the present Emigration Commission last a long time and impose a good deal of work on the members and I do not think that the public generally realise that apart from the country members who are allowed travelling allowances and subsistence expenses no one acting on those commissions gets any money even to meet their expenses. The same thing applies to professional people who give their time on other boards and selection committees such as the Civil Service Commission. These fréquently last for days and all that service is unpaid.

The fact of the matter is that there has come about a revolution in society of which the Government has not taken notice. Fifty years ago, the whole of society in this country was based on existence of a privileged leisured class and the people in that position were able to give a good deal of free public service. In these days of higher taxes, increased prices and other such things the people who were in those classes are now probably the poorest sections of the community as compared with those earning regular salaries. You had in those times a different set of circumstances from those operating in the country to-day. There was then and there is still in Great Britain a type of non-pecuniary reward which people valued and they were prepared to undertake in return for these awards free services on various boards and bodies. Those people got nothing in return for the time they gave save these rewards of which I have spoken but their services were not less valuable for that.

In these days of high taxation, high prices, and egalitarianism there has been a levelling down and that has got to be recognised. Those privileged classes are no longer in existence. In the changed conditions of to-day professional people are asked to do a great deal of free public service and I have no doubt that they will continue to do it. Business men and trade unionists are not asked, as a rule, to give these services without payment but there is this academic class who are always called on to do these services on all commissions. I am not saying that they are unwilling to do them. They are prepared to take them on but the fact that they are willing to do these services should be recognised and I do not think the Government should expect them to have all these expenses without giving them some sort of compensation.

I do not know what system of remuneration could be devised but I would favour the payment of a fee for attendance. I do so for three reasons. The first is that it will keep up attendances, secondly it does give the people on those bodies a sense of responsibility, but I am not saying that without remuneration they are not going to give as good service and finally on bodies where one gets a fee for attendance the feeling of getting something for nothing does not arise. If you do not turn up you feel that you are not doing anything wrong when you know you are not getting a fee for that day. That does not however take from the interest in the work of a particular body.

I do not want to press this matter any further. I only speak about it at all because it affects a class of people in whom the university representatives are particularly interested. I ask the Minister to reconsider this whole question and to find some means of providing some sort of attendance fee for professional people on these commissions and boards.

I should like to give some of the reasons which, to my mind, are responsible for the shortage of nurses. I agree largely with what Senator Ruane has said. We must remember that there is very fine material in every part of the country, but I am speaking mainly of the West of Ireland, and there are a number of parents there who could not possibly give a fee of £50 or £100 for the training of their daughters as nurses. I have in mind a case of a young lady about 40 years ago who went away to a hospital and who had to pay a fee of 52 guineas. She spent four and a half years in training and was allowed £12 for the first year and £20 for the second. I thought those days had gone, but I understand that the fees to-day are as high, if not higher. The result is that numbers of these girls who have a taste for nursing baulk when they see the conditions and what relatives and friends of theirs had to go through. In my own district, in the past nine or ten years, 40 or 50 girls have gone to England because their parents were unable to pay the fees. They are paid as probationers in England.

The remedy that I would suggest is a system of State subsidised scholarships. Scholarships are provided in the Universities for people who propose to engage in other walks of life, and, in view of the fact that nursing is one of the noblest professions—it is really a vocation—it is up to those concerned to do something special for the right material for the profession. There are families with five or six girls and the parents are able to provide the necessaries of life, but unable to put anything aside. They expect some help from their families rather than to have to give it. With a little encouragement, in view of the existence of this robust material with a leaning towards nursing, I do not believe there would be any reason for a shortage of nurses.

With regard to nurses duties in hospitals, I hold the view that the duties of probationers should not consist entirely of wardsmaids' work. They go there to be trained as nurses and they should be so trained. Possibly some work of this type might be given to them to give them an idea of the running of a hospital, but it should be as little as is necessary and there should be a concentration on their real training. Up to ten years ago, nurses' remuneration, after being trained, was very bad. I know cases of salaries in county and district hospitals of £30 a year, with apartments and rations. That was the usual rate of pay and these nurses were supposed to do anything up to 12 hours duty a day.

I am personally aware of cases in which nurses were kept on night duty for practically six months. I read some years ago a statement by a medical authority to the effect that the life spell of girls who engaged in nursing for 25 or 30 years was reduced, on the average, by ten or 12 years. When girls see what these nurses have to go through and see their sisters in other walks of life having a very different time, it is no wonder that we hear complaints about a shortage of nurses. I am sure that, in speaking of these matters, I am pushing an open door because the Minister has shown, since he became Minister, that he is very sympathetic towards the welfare of nurses.

I understand that a secondary education is a condition of entrance to hospitals. I remember girls with good, sound national school educations being taken into these hospitals and making very fine nurses, and I am of the opinion that it is still quite possible to find such people of average intelligence who would make perhaps better nurses than university graduates. I admit that there must be a certain standard of education, but I do not think the rule should be too rigid or that an extraordinarily high standard should be expected. A number of these girls— good material for the nursing profession—are not in a position to have a very high standard of secondary education and that should be taken into consideration. If they are strong and willing and if they have the vocation, they should be given facilities to train, and, even during their training period, arrangements could be made for the giving of some kind of extra lectures in order to raise their standard of education. These facts which I have put to the Minister represent the position as it exists in a great part of the West of Ireland.

It gives me considerable satisfaction indeed to have been the means of introducing this Bill which, I believe, is going to make some contribution towards an improvement in the standard under which nurses are trained and under which we can provide post-graduate education for girls who aspire to the higher supervising posts in our hospitals. As I said very recently, and repeated a number of times, I have for the nursing profession in Ireland the very highest respect and regard. These words are not mere lip sympathy or common sentiment but are derived from a number of years of very close association with nurses in Ireland, and also during some of my own post-graduate education in England with some of our girls who had emigrated. In addition, like many others, my respect grew from the very close association which one can get of their character, their integrity, and their extremely high standard of ability in the nursing profession, which one gets as a patient in any of our hospitals.

From these experiences, and also from a fairly close knowledge derived from my association with nurses in different ways, I have come to have very deep sympathy with these ladies, and a belief that we have not, in the past, treated our nurses as fairly as they so richly deserved. In spite of this, and not because of anything I have done, I believe that we have turned out, over a number of years, nurses of the very highest quality, nurses whose whole tradition and outlook followed closely on the ideals set for them by centuries of long tradition of nursing, which we know of in the nursing religious communities for over 1,000 years. I believe that our nurses carry on their profession in these high Christian traditions. I also believe that if many of them emigrated—and I am afraid that numbers of them have—they had, to a large extent, tended to take the place of the medical ambassadors which we used to send abroad in years gone by.

Nowadays were are noted for the extremely high quality and integrity of our nurses, due to the many years of service which these girls have given to the sick of many races in many countries. They brought nothing but credit, indeed, on our country. Our main duty now is to attempt to ensure that our girls, who are anxious to take up the profession of nursing, should be given every possible assistance. Consequently, as a step—a limited one— we have before us this Nursing Bill. I am very grateful to a number of Senators who gave me the invaluable assistance of their experience and advice.

I think, as Senator Bigger stated, that this is a good Bill and that as a result of suggestions that have been made we may be able to improve it. Senator Bigger referred to a number of very important points. I should like to join with a number of other Senators in congratulating him on his treatment of this Bill and on his suggestions. The first point is a small one and can be easily dealt with. It concerns the name of the board. In my opening remarks I did not refer to An Bord Altranais for the reason that I was speaking in English and, consequently, it would be inappropriate for me not to continue using the same language. I think we will be able to meet Senator Bigger's suggestion regarding the English title of the board.

The Senator also referred to a number of other points, (1) the threat hanging over a committee or board from the Minister, of summary abolition, which he felt was undesirable. While that is an important point I draw the attention of the House to the fact that in the Midwives Act, 1944, Section 16, there is a condition which says that "the Minister may at any time, by order, remove any member of the board from office". That, of course is not a sufficient reason for keeping any weak section in this particular Bill, if it is considered to be weak. It says that the Minister may at any time by order remove any member of the board from office. That is not sufficient reason for keeping any weak section in this particular Act, if it is considered to be weak. The first consideration in any question such as this, is, I think, that recent experience has shown that Ministers no longer, anyway, would readily abolish any board. I think it can be assumed that prior to any question of the dissolution of a board it is only reasonable to expect that numerous representations would be made to that board if it was not behaving in a proper manner or if it was not carrying out its functions adequately. Any reasonable Minister and, I think, from comparatively recent experience of the results of such action, any unreasonable Minister would think twice before taking such action.

Senator Bigger raised the matter of appeal in relation to the question of removal from the register of a midwife or of a State registered nurse—the question of whether it should not be made to both the Minister and to the High Court, and the dilemma of a nurse who is faced with the prospect of appealing to one or to the other. I was rather anxious that this should be included. It is a common enough undertaking. It occurs in many such Acts, the reason being that if one had an unreasonable Minister then one could have recourse to the High Court. In normal times the obvious action would be for the nurse to carry out the ordinary procedure of writing a letter to the Minister, which action forms the appeal. That is common practice. Every day my Department, and the same applies to every other Department, receives letters from many sections of the community— employees, people in receipt of allowances of different kinds, appeals against local authorities and so forth —and that is generally accepted as a normal routine. I was anxious to include the question of the High Court in anticipation of the appalling thought that there might be such a thing as an unreasonable Minister at a future date.

Another point which was raised referred to the right of a lady, who is charged, to make a personal appearance or to be represented before the trial body. This is a good point. We shall be glad to deal with it on the Committee Stage and we shall try to meet the Senator's objections. I would say, with regard to the right of the maternity nurse to be tried by her peers, that that is another excellent point with which we are in agreement. We feel that we will be able to increase the representation of the maternity nurses on the sub-committee of the main board so that the maternity nurses, who are primarily involved in this question of disciplinary action which may be taken against them, will be tried by a committee which is representative of their particular branch of the profession.

Senator Bigger raised a hypothetical argument in which he envisaged a rather calamitous series of events whereby the various bodies represented on this board—people such as the Medical Officer of Health Society, The Irish Medical Association, my representatives and odd Masters of maternity hospitals—might suddenly be subjects of revolutions, internal or otherwise, and that we would have a position in which a completely immature or inexperienced board might be appointed. The Senator suggested that we might have the question of staggered elections. I do not believe that this coincidence of events is ever likely to happen and I do not think that we would get any real assistance from the proposal which he has suggested.

Senator Bigger and Senator O'Brien, mainly, I think, referred to the question of fees in relation to voluntary service. It came as rather a surprise to me to be given to understand that at such a very high level the voluntary tradition was tending to suicide. I feel that there are very fine instincts in the citizens of this State—instincts which will permit them to act on such boards from time to time for the sole reason that their service is of value to the community. I should imagine that it might be a retrograde step to try to put any value on the service which these distinguished men and women might be asked to give to the community on boads such as these. I think there would be difficulties in the compensation of the different members of these boards as to how much would compensate a public health nurse and how much would compensate a university professor. It would appear to me to raise some very difficult and awkward questions and I am not completely sold on the idea that the voluntary tradition is yet quite dead.

A number of Senators, Senators O'Farrell, Ruane and Ó Buachalla, raised the question of fees to be paid by nurses in relation to the difficulty in getting nurses. Of course, those two remarks are mutually contradictory because one of the reasons that fees are still being paid in our hospitals is that our hospitals can still afford to pick and choose. The reason why it is not necessary to pay fees in England is that there is a shortage of nurses. My belief is—I may be wrong—that if we persist in our attitude to the nurses, if we do not take a more rational and liberal view of their necessity to the proper development of the country, we will also find ourselves in the position where fees will no longer be necessary, but for quite different reasons, the reasons being that we will not have a waiting list of young girls anxious to go into our voluntary and local authority hospitals. At present I have no functions in relation to the voluntary hospitals beyond occasionally making allocations of money from the Hospitals' Sweep Fund. The only functions I have in respect of nurses are in the local authority hospitals, the county hospitals and hospitals like the Galway Central and St. Kevin's Institution in Dublin. Where we have training hospitals in the local authority service no fees are payable. Fees are payable only in the voluntary hospitals. We are trying very hard to extend the training facilities in the local authority hospitals and have approached a number of the larger county hospitals to ask them to try to get sanction from the General Nursing Council to set up as training institutions for these girls in order to try to provide opportunities for probationers to get training free of charge in this country. That has been tried in Mayo, Roscommon and Kilkenny. Different approaches have been made and we are hopeful that it may be possible to arrange this in certain cases. In the establishment of St. Kevin's Institution as a post-graduate school, it is not unlikely that we will also have nursing training facilities where girls will be able to become nurses without the necessity of paying fees. I know of a number of girls myself who have had to emigrate because fees were payable. They were a good type of girl who would have made very fine nurses but there is the consideration that there are waiting lists at the moment and local authorities can afford to pick and choose and if they can pick somebody who can pay a fee, they are rarely loath to choose her.

I think it was Senator Hawkins who was interested in whether we had consulted about this Bill with the two bodies involved. As a matter of fact we had continuous negotiations right from the beginning with both the Central Midwives' Board and the General Nursing Council. They saw the general proposals and were informed throughout of the progress of the Bill. Any suggestions which they had made had, as far as possible, been incorporated. The General Nursing Council are quite content about the establishment of this joint body. They were not completely happy about the disciplinary committee set up to control the midwives and, as Senators have suggested, there was necessity for compromise, but we were able to arrive at some kind of compromise by setting up this sub-committee of the main body to look after disciplinary and other functions in relation to the midwives. Negotiations are still proceeding with the Central Midwives' Board and we are, of course, prepared to receive representations at any time from either of them.

Senator Ó Buachalla felt that we were not really doing anything in this Bill. I am not going to pretend that we are going to revolutionise the living or working conditions of our nurses by the introduction of a Bill such as this, but I do believe that it is a progressive step. What we are doing is amalgamating two bodies who do certain jobs and we are setting up one body to do that work and beyond that there is little else. The new body has functions which are considerably in excess of those held by the two bodies now to be amalgamated. They have the old power of registration but they have also the power of training and the setting up of scholarships in which Senator O'Farrell is interested for girls who show enough ability; they have the power to lay out post-graduate courses in the hospitals in the local authority and health services and in the universities if possible for girls who have sufficient ability and interest to be anxious to proceed to a higher position. They will also be able to build hostel accommodation for these girls during the post-graduate education in which Senator O'Farrell is interested. Senator Ó Buachalla also wanted to know whether the board would publish an annual report. They will publish an annual volume of accounts and it has been laid down in Section 22 that they should publish an annual report.

Two Senators were anxious about rates and the effect of this Bill on the rates. The case of County Leitrim has been specially referred to by Senator O'Reilly. I know very well that the position of County Leitrim is a very difficult one but we are adverting to the principle followed in this Bill, that the expenditure involved other than capital expenditure is to be divided between the Central Fund and the local authorities. That is a principle which has already been established under the Health (Financial Provisions) Act which now controls expenditure by local authorities and we are not introducing anything new here. We feel that the local authorities are going to gain by having a higher standard of public health nurse. A higher standard of public health nurse means less disease and less disease means less expenditure, and looked on in that light this is going to be good business for the local authority and everybody else.

Senator Mrs. Concannon referred to the absence of a tubercular nominee on the board and the absence of a member of a religious community. Certain nominations are left to me and this, of course, leaves it open to me to appoint nominees such as these. Again members of religious communities are in a number of cases matrons of institutions and I presume they would be eligible for election on to the board as constituted.

Senator Dr. Barniville and a number of other people referred to the conditions of the nurses in training in Dublin and our other cities. As I have said before I do not think better nurses are trained anywhere in the world— in my experience—and certainly none better in any part of Europe but I do believe that these girls do not live, in a number of cases anyway, in the best or what might be called ideal conditions. We in the Department in relation to the local authority services have, as you probably know, introduced certain conditions of service including a 96-hour fortnight. Also there is a superannuation scheme to which Senator Concannon referred.

Another point referred to by Senators Barniville and O'Farrell and others is the question of the way in which these girls live, the possibility of unnecessarily strict discipline and the general attitude of recalcitrant schoolgirls etcetera. I do not think it is universally so but I think there are cases in which the disciplinary position is too stringent and in which the girls could be allowed more freedom. We have progressed a lot since the days of Sarah Gump and from the days when girls lived in shelter and protected surroundings and we must accept these facts. We have recommended that all unnecessary discipline should be avoided, and that recreation facilities should be provided. For instance in country hospitals outside the cities and big towns we are always very glad to sanction the provision of station wagons or other means of conveyance to help to get the girls into the larger cities and towns.

In a Nurses' Home which we built recently of 120 beds we feel that the facilities in that Home are such as we would like to see extended to other areas. It is a temporary building but each of the girls, probationers and trained nurses, has her own separate room and each branch of the nurses probationers, trained nurses and administrative staff, has its own sitting rooms, lecture rooms, recreation rooms and rooms into which they can bring their friends and relations when they come to visit them. We want to have the conditions brought in so that girls when off duty will be able to behave just as if they were in their own home. These are improvements which I believe are going to make our girls feel that far off hills are not so green and things are much better at home where they will be looking after their own people and caring for their own people, which surely is a thing they will prefer to do.

The board to be constituted under this legislation enacted by the Oireachtas will have all the powers to insist on improved conditions for nurses and if these conditions are not brought about by the training school then they have power to recommend to me that the training schools should no longer be recognised and should be closed down. This I believe is a considerable advance and I sincerely hope it will not be ever necessary to use those powers.

Senator Butler referred to the use of this body as a form of trade union, as it were, to recommend rates of wages, etc., to be introduced by me or by the local authorities. This, in my opinion, would not be a proper function for this board. There are similar bodies such as the Irish Medical Association, the Medical Officers of Health Society and also the Irish Nurses' Organisation and it is largely their function—certainly it is so in the case of the Irish Nurses' Organisation—to cater for the financial or economic condition of their members. I think they can be said to look after these responsibilities very efficiently. There is nothing to stop this board making recommendations to me in regard to anything, but I do not think it would be proper for them to interfere, as they would have to, between the employer and the employee in respect of wages, particularly as they would be in the position of inspecting an institution or hospital, with the possibility of suggesting that it should be discontinued as a training institution. The combination of both powers would, I think, be undesirable and the Irish Nurses' Organisation, as I say, is a live body which is doing its particular job very well.

Senator O'Farrell was a little worried because we keep the sub-committee of the board and he feels that there is some differentiation between our treatment of midwives and the ordinary nurse. The reason for this is, first, that the Central Midwives' Board was very anxious that we should retain some form of disciplinary committee in order to cater for these under the new board. There is a difference between the conditions of work of the ordinary State registered nurse, the hospital nurse, and the maternity nurse. One is working continuously under the supervision of a sister, an assistant matron and the matron of the hospital, while the other is practically all the time out on her own under the intermittent supervision of a dispensary doctor and sometimes working completely on her own. It is quite obvious that it is very necessary to keep some kind of control, in regard to disciplinary action, anyway, over this section of the amalgamated board. This committee has been suggested by the Central Midwives' Board and we thoroughly approve of it.

I do not know if it may be possible to meet the objections of Senator Bigger in regard to the problem he raised of the sudden abolition of the board by the Minister, but I will bear the points he raised in that regard in mind, and, if I can come to any arrangements which would appeal to him better, I shall certainly do so, but I cannot say at the moment how that could be done. I hope I have been able to cover as many as possible of the points raised and I should like to repeat that I have benefited considerably from the very useful discussion which has taken place here on this Bill.

Question put and agreed to.

It is proposed to take the Committee Stage, if the House agrees, at the first sitting after the Recess, but not earlier than Wednesday, October 5th, the intention being, as this Bill has been introduced in this House, to sit for two or three weeks, if possible, before the Dáil resumes and get this and some other measures introduced here through.

Committee Stage ordered for first sitting day after the Recess.