In a short contribution on this very important piece of legislation, I wish to commend the Government, the Minister responsible and his Ministers of State for the interest they have shown in this Bill. I wish to thank them for the widespread consultation and debate they had with all the interested parties. This led in no small way to an excellent debate in the Dáil on this legislation and to some fundamental amendments being agreed by the Minister. He had wide-ranging discussions with members of the Irish Nurses Organisation, the Irish Transport and General Workers Union, the Federated Workers Union of Ireland and many other trade unions and associations representing nurses in various ways. It was because of that widespread discussion that there is now, generally speaking, a warm welcome for the terms of the Bill which has passed through the Dáil and is now before us.
The purpose of the Bill itself is that An Bord Altranais, who were established in 1950, will be abolished when this Bill becomes law and will be replaced by the Nursing Board. The composition of the Nursing Board has improved in regard to the representation of nurses on it. That was one of the areas that concerned nurses. They wanted to ensure that their profession would be adequately and majoritively represented on the board. Arising from amendments and various representations, not fewer than 18 and possibly up to 20 nurses out of a total board of about 29 will now be on the board.
I also welcome in the Minister's Second Stage speech the commitment to seriously consider, in making regulations, that the voting procedure to be adopted by nurses in electing their members would be proportional representation. If we draw a comparison between this legislation and the Dentists Act, which was put through this House after some considerable debate, discussion and amendment which produced very fine legislation at the end, a similar section was conceded by the Minister. I am glad that he has now given an assurance that, in making these orders setting down the procedure, he is seriously considering the use of proportional representation. We welcome this because there are certain sections of the nursing profession who in the overall context might be in a minority situation but under the PR system of voting would have an opportunity of ensuring that their voice would be heard and represented on the board.
Regarding the functions of the board, most of us would welcome particularly the area of the registration of nurses, the whole area of the setting of standards of nursing and the minimum standard of educational requirements for nurses. I am sure that when we talk about the minimum standards of education required the incoming board will have regard to the recommendations of the working party on general nursing. Many of us, including yourself, a Leas-Chathaoirleach, I am sure, have views on the educational requirement of nurses. Nowadays we seem to be obsessed with academic achievements of people who are considered suitable to be even interviewed for nursing. We have many people who would achieve the minimum requirements and above the minimum but because of the numbers of applications from young girls for nurse training, training schools themselves have set a higher standard and that higher standard is usually based on academic qualifications. I admit that biology and chemistry are essential subjects for nurses but it is debatable whether mathematics or anything else should be that important.
Apart from being a very professional and dedicated body of people nurses also have a special qualification which has nothing to do with education. That is a vocational qualification: the ability to be kind to people who are sick or old or infirm. I would hope that when minimum standards for entrance to training are being set, that attitude would be considered as being a very important and necessary minimum educational requirement. We should ensure that instead of having hundreds of young people qualifying on the basis of seven or eight honours in the leaving certificate, those who would have the minimum standards in the important subjects plus the ability to be able to deal with people would also be considered. That might need some change in the curriculum or otherwise in our second level schools. It is important that at least I put it on the record of the House that I consider that to be a very necessary part of any qualification to be a nurse. Apart from being a job nursing is a profession, a vocation and something that many girls we talk to in the country aspire to. A girl with an excellent leaving certificate might make a great banker but might not make a very good nurse.
The system of central application which has been talked about in the Bill and which has been the subject of some controversy is one that has to be welcomed. We have the problem at the moment of the same girls having to apply to five or six different locations, to different training schools or hospitals, seeking interviews that would result in their being placed on the panel for nurse training. If the system were centralised and some definition laid down by the board of what the requirements were, it is possible that interviews could be carried out at regional level and that the results could be sorted out at central level. Girls who may be successful in one area fail in others though the requirements may be the same. By rationalising this procedure in a central way girls could be spared some of the financial burden that is now placed on them by reason of their having to apply to the various health board areas.
Another very important function of the board which has led to some degree of debate — I will not say controversy — was the power of the board to remove nurses from the register. They could be removed for any of a whole list of reasons which are included in the Bill. One of these is professional misconduct. There was a reservation that any board would have that power. In speaking with nurses who raised this problem with me, I was glad to assure them that the members of any profession in this country, whether doctors, dentists, veterinary surgeons or otherwise, are expected by the public to attain and adhere to a certain code of conduct.
I have no doubt that the vast majority of the nursing profession would welcome that provision. It is appropriate that they maintain a certain high standard which all of us accept and expect them to maintain. From our experience of dealing with nurses on health boards and in hospitals and so on they have this tremendous high standard of professional conduct, no provision in the Bill insinuates that there is widespread departure from this but it is appropriate that if their profession is to continue to have this high standing in the public mind, the safety valve would be included that the board have the power to remove from the register a nurse who was found to be guilty of misconduct.
There is another section which gives the board power to bring in ancillary grades of nurses. This has created some concern particularly when we have regard to the large numbers of nurses who are unable to obtain employment in hospitals, nursing homes, health boards or otherwise. They find it difficult to perceive that we are now possibly going to create a category of people who are not nurses but who are allied to nursing. In some professions this is to be welcomed and is necessary because we do not have sufficient qualified people to carry out all the functions they would normally carry out. In the Dentists Act we created certain groups who with proper training could do a lot of very important work that dentists do not have time to do. In the area of nurses and ancillary grades of nursing I would have reservations about the urgency factor in view of the fact that there are so many unemployed nurses available for work. I am personally aware of such people and most Members of this House would be aware of them also. I should like to think that they would be employed before anyone else would come in as a second tier or lower tier to be provided with a certain status which would be included in the functions of the board.
In saying that I know there are some girls who because of the educational requirements or for some other reason will never be able to qualify as nurses but who will spend their lives caring for the sick or the infirm or the mentally handicapped. Perhaps in the area of mental handicap there is a place and a need for this ancillary type of nursing. I would have certain reservations about ancillary nursing grades in general hospitals, geriatric hospitals and so on, but in the area of mental handicap there probably would be a need for this ancillary type of person who would be very good and extremely kind with these types of patients. In that regard I hope the board will take into account that type of person if they decide to have a second tier of nursing type personnel with a certain type of registration in this new board.
The other area is one that is really controversial and that is the area of the right of nurses to object to carrying out particular medical functions which could in fact contravene their own conscience or moral judgment. All of us accept that in any walk of life, in any profession, people should have the right to opt out of particular medical operations or otherwise that could create a conscience problem for them. The discussions we have had with nurses organisations in this regard indicate that they are satisfied that this was not the area which was included in the section that gave the Minister certain powers of direction. It did not impinge on their moral and conscientious right to object as a profession, as indeed the professional ethics they acquire on the day of their graduation would have given them in any case. I want to put it on the record that that principle should be enshrined in any legislation. We are living in a democracy in which people would have the right to opt out of any procedure that would be in conflict with their conscience.
Generally speaking the provisions of the Bill are ones that I welcome. They are long overdue. The nurses themselves are anxious that we as a House would complete this legislation as soon as possible so that the board may be set up. I welcome all the efforts that have been made to tidy up all the anomalies that apparently had been there in the past and hope that with this new surge forward in the importance of the profession the nurses will respond magnificently, as they always have done in the past. I commend the Minister and his Ministers of State for the interest they have shown in trying to ensure that the legislation reflected their views because they are the people who will be involved in the carrying through of this legislation by way of the setting up of this new Nursing Council.