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Seanad Éireann debate -
Wednesday, 16 Oct 1985

Vol. 109 No. 4

Nurses Bill, 1984: Committee Stage.

Sections 1 and 2 agreed to.
SECTION 3.
Question proposed: "That section 3 stand part of the Bill".

This is a normal provision in recent Bills in relation to the date when the Act will come into operation. Would the Minister of State indicate the Government's intention in this regard? We have had examples of legislation which has been passed by both Houses and then many months, sometimes even a year, elapsed before the Act was brought into operation by order. It would be helpful to the House if we had some idea of the Government's intention in this regard.

There is no difference in the Government's intention for this and other legislation. It is possible that the Senator is referring to the Dentists Act, where the Minister made an order to bring a necessary part of the Act into operation. The remainder of the Dentists Act will come into operation next month. I presume a portion of this Bill will not be different.

Question put and agreed to.
Sections 4 to 8, inclusive, agreed to.
SECTION 9.

I move amendment No. 1:

In page 9, subsection (1) (d) (ix), line 31, before "nurse" to insert "trainee".

This amendment is to facilitate many of the student nurses. The Minister has gone out of his way to facilitate nurses in that out of 27 members on the board there is a total of 17 nurses. The Bill is providing for the registration, control and education of nurses. In the various universities the boards of management on the governing bodies have representatives from student unions and it would be a very fine gesture if the Minister could have a student nurse on this board. This is something I feel quite strongly about. It was suggested also on the Dentist's Bill.

Are we on the amendment? May I speak on the section?

We are on the amendment.

As Senator Fallon pointed out, the effect of the amendment would be to provide that the Minister of the day would appoint a student nurse instead of a nurse to the board. I regret that I cannot accept the amendment. The reason is that the nature of the board's role and their functions do not lend themselves to the appointment of a student nurse as such. During the Second Stage debate here I said that I would welcome and very positively favour student representation on the boards of hospitals. These boards manage the services which the students play a major part in providing. However, the national Nursing Board, An Bord Altranais, are not involved in any way in the formal management of nursing services. Their purpose is the registration of nurses after they have qualified, generally deciding on examination procedures, the educational curricula and the control by way of the fitness to practise procedures of the profession.

To enable the board to fulfil that distinct role, the members of the board should, in the first instance, be persons who have qualified as nurses who have basic experience both in the teaching area — as teachers they would be involved in the drawing up of curricula — and in the setting of examinations. They would also have to have experience in the clinical area in order to do basic examination work and basic fitness to practice assessment. Of course, they would have to have experience in the administrative area, for example, as chief nursing officers, matrons and so on. On that basis, I would not consider it appropriate that there should be formal student-nurse representation.

I have authority, under the Bill, to appoint one nominee of the Minister. I am of the view that the nominee should, as far as possible, be a nurse and not a student nurse. As the House knows the extent of ministerial nomination is extremely limited because it is overwhelmingly an elected panel of persons from each of the areas of the profession. It is on that basis that we will have the appointments made. If I may draw the analogy, it is rather like having students on the boards of universities. On the examination authorities they are not formally represented.

I am not happy but I will have to accept the Minister's ruling.

Do I take it that the amendment is withdrawn?

Amendment, by leave, withdrawn.
Question proposed: "That section 9 stand part of the Bill".

Unfortunately because I had to move the adjournment of the debate I was unable to deliver the remainder of my Second Stage speech, but the Minister seems to be of the opinion that I was going to take him to pieces in my speech. That was not my intention.

We are now on Committee Stage. Under section 9 of the Bill nurses working in special hospitals are banned from election to An Bord Altranais, that is, orthopaedic, cancer, geriatric etc. Also, paediatric hospital nurses have only one opportunity to be elected — under 9 (1) (a) — and they feel that they should have been included in (b) and (c). The Minister gave an assurance to the INO that he would nominate one nurse adviser. The nurses feel quite strongly about section 9 (1). They feel that the same provision should be in 9 (b) and 9 (c).

Regarding the composition of the Board, in his opening address on Second Stage, the Minister talked about the flexibility and the power, by regulation, to vary the composition of the membership of An Bord Altranais. That means that perhaps at a later stage the original composition could be changed.

I make the general point that we have 29 members on the board and 17 of those will be elected nurses. If we were to expand the board any further and bring in all the various specialities—quite a number of specialist areas have approached me about being included — the situation would become totally unworkable. If I were to include further specialisation in the other areas, both the teaching area and the general administrative area, we would never finish expanding the board.

The provision in section 9 (3) is a standard one for this type of health legislation and it is an important element to include in relation to a board of this nature. The purpose of section 9 (3) is to ensure that the composition of the board can be changed to reflect the nursing needs of the day in future years. This new Bord Altranais will stand for quite a number of years but, undoubtedly, in the years ahead there will be further developments in medical and nursing education, in practices and in procedures. The board will be the first to come back to the Minister for the day, to point out the need for change as it may arise in the composition of the board. My only intention in section 9 (3), is to give power to amend the Act by regulation after consultation with the board. That is the important issue. It will not cause any great alarm. I want to get this Bill as definitively decided as possible but the parliamentary draftsman advises that, rather than having a whole new Act, it is better to put in a regulatory provision in this section.

On the question of a replacement on the board, assuming somebody goes off to another job, or dies, or something like that, how will the vacancy on the board be filled? Will it be the next highest person in the election? Is it the Minister's role, or is it the board's role?

In paragraph 6 of the Second Schedule there is a specific provision for the filling of casual vacancies. The casual vacancy is there. It is a very clearcut procedure. Section 6 (b) of the Second Schedule provides that whenever a casual vacancy occurs among members of the board appointed by election the board shall co-opt a person who is eligible for election to fill such a vacancy and any person so co-opted shall serve as a member of the board for the unexpired period of the term of office. It is a standard procedure. The Minister fills the vacancy following consultation.

That will arise under the Schedule.

Let me come back to Senator Fallon's amendment which I understand has been withdrawn now.

No. That is under another section.

It is in section 9.

It has been disposed of.

The Minister said in relation to subsection (3) that he is empowered by regulation to vary the provisions of subsection (1) which constitutes the board and specifies the sections of the nursing profession and of society generally from which the members shall be drawn. The Minister does not like to tie his hands behind his back, but I ask him with tongue in cheek if, in the line of Senator Fallon's amendment which has now been disposed of, he could give an undertaking to the effect that one of the two members, two persons representative of the interests of the general public, will represent the student interests on the board. It seems that the board as constituted could end up as an elderly board constituted of experienced nursing politicians. I do not mean that in a party sense but within the nursing, medical and paramedical professions.

I do not think I could give the assurance because already the Minister's powers of appointment are extremely limited and he would be span-celling himself. At the moment the Minister will be appointing very few people to the board. I would be more disposed to giving an assurance that I will look at the composition of the elected board. There may be specialities, for example in the paediatric or geriatric areas, where nobody would be elected, and then to bring a balance to the board one would try to fill in some area. There may be, for example, major developments in cardiology and one might seek a nomination in that regard. Regarding the public representatives, I have given one broad assurance — because so many trade unions are directly involved in the nursing area — that I would consult with the Irish Congress of Trade Unions to seek their views on who best would fill those vacancies, but that is as far as I would go at this stage.

Let me bring that a little further. I know the willingness of Ministers to consult with interested bodies such as the Irish Congress of Trade Unions. Let me ask the Minister in line with that thinking to consult also with the bodies who represent the trainee student interests. That is one interest which should be represented on the board. I appreciate and applaud the Minister's openness in saying he will consult the unions' interests but that should also be done in relation to the students. If you do not do that and if you ignore the possibility of student representation on this board then you are going to end up with a well heeled, articulate middle aged board who will not represent the broadest possible nursing interest. The Minister's past statements in relation to many issues have suggested that he would favour broad representation on a body such as this board and I ask him to give the same undertaking in relation to student interests as he has in relation to labour interests.

This brings us back to the problem of the Bill. I have had great difficulty in explaining this issue to student nurses, of whom there are 6,500 in the country, that it would be inappropriate for them to be members of An Bord Altranais. For example, if an issue arose in relation to fitness to practise and a registered nurse was to be taken off the register because of very serious complaint, it would be inappropriate that a trainee student nurse should be a member of the fitness to practise committee of the profession, and he or she if a member of the board would automatically become a member of the fitness to practise committee. There is no preclusion as such and there could not be. Therefore, he or she would adjudicate in a legal statutory manner on the fitness to practise of a registered nurse.

Equally a trainee nurse could be elected to the board, serve a full term of office on the board, never pass his or her examinations or qualify as a registered nurse and still be a member of An Bord Altranais. The outcry from the nursing profession in those circumstances would be, to say the least, very considerable. I do not have pressures from the student nurses for formal representation on An Bord Altranais. Any approaches on that line have been marginally exploratory in terms of an explanation of what it is all about. Consultation with the particular interest would be a question of consulting with the trade unions concerned. They are affiliated to the ICTU and they come back to me on that basis. It would be inappropriate that student trainee nurses should be on An Bord Altranais.

Question put and agreed to.
Sections 10 to 12, inclusive, agreed to.
SECTION 13.

I move amendment No. 2:

In page 10, subsection (3), lines 35 and 36, after "section" to delete ", other than the Committee referred to in subsection (2) of this section".

I put down these amendments, taking the second one first, to tidy up the overall section. Reading through the Bill as it stands one does not really know what the fitness to practise committee is until one reaches Part V of the Bill. There is a broad definition in section 2 but that simply leads one to section 5. Section 13, which has a direct relevance to the fitness to practise committee, should include amendment No. 3 which I am putting before the House.

It seems that the fitness to practise committee should have within it somebody who is not a member of the nursing board, who is not a nurse. The idea of lay participation should be within it. It is interesting at this time that we are debating the issue of a Garda complaints procedure and disciplinary procedures within the Law Society, the body who control solicitors. Within the latter body there is an acceptance that there should be lay participation within their disciplinary procedures, and there is now an acceptance across the board political spectrum that there should be lay participation within the Garda disciplinary procedures. The same should apply in relation to the fitness to practise committee of the Nursing Board.

It can be argued that there may be people on that committee who come within section 9 (1) (d) who might not be nurses, but there is no necessity, no obligation on either the board or the Minister to ensure that that is the case. In the interests of the nursing profession and also of the public there should be a guaranteed right of lay participation on the fitness to practise committee. When I say "lay participation" I mean responsible lay participation, in that very important committee. If that is done you are protecting the nursing profession in that you are not leaving them open to the kind of abuse that may be levelled against them by an aggrieved member of the public who may say that members of the fitness to practise committee all come from within that board. You do not want to have a vested interest in one sense or another. It can be argued that the nursing board do not consist entirely of nurses, but generally the weight is in favour of nurses. I move these amendments to ensure first that there is within that fitness to practise committee somebody who is not a member of the nursing board and who has not, as it were, an inside vested interest. This is also protecting the public in that it gives the public an assurance that it is not all an internal nursing board procedure.

I am also aware that one can appeal to the health board against decisions of the fitness to practise committee, but in the initial stages there should be the kind of openess within that board that is desirable, and that is not there. I ask the Minister either to accept my amendments in this regard or, if he considers the idea further, to bring in a ministerial amendment on Report Stage.

I appreciate the Senator's concern in proposing these two amendments. I share his concern to ensure that the members of this very important statutory committee will be seen by the public to act in a totally unbiased manner in carrying out their functions under the Act. However, there are adequate safeguards from a public point of view which are of quite different composition from those of the Incorporated Law Society, for example, who have been alluded to and I share the Senator's views there.

However, section 13 (6) provides that: " . . . at least one-third of the members of that committee shall be persons other than persons who have been appointed by election to the Board." Therefore, we have one-third. There is no guarantee that they will come forward from the one-third, but among the 12 appointed members will be two representatives of the interests of the general public, together with at least seven other persons who will not be nurses. For example, four of these will be neither doctors not nurses. On that basis these four will come from the areas of health board management, from the management of the voluntary hospitals sector, from the Department of Health and from the Department of Education as such.

These board members are eligible to serve on the fitness to practise committee. If they never got on to the fitness to practise committee they would still have a very strong opportunity to influence the decisions on how the board should act and report back to the fitness to practise committee. Therefore, I am reluctant to provide specifically for a person who is not a board member to be included on the fitness to practise committee. The reason for my reluctance is that I have a difficult Bill to get through, already within the framework of the legislation relating to the medical profession, and one relating to the dental profession, which also is a very difficult enactment. I have not such an outside involvement in the fitness to practise committee and I am dubious, with no fewer than 12 non-nursing people on the board, about any great benefit or advantage to the public accruing from the amendments as proposed. These are my basic reasons, but I can indicate to Senator Durcan that in setting up the board I would prefer to request the board, not in a statutory way, to make quite sure that at least one of the public interest members appointed is put on the fitness to practise committee, and we could review the situation after that. At present I regret that I am not disposed to accept the amendments as framed.

I accept the Minister's point that he has to get through a very difficult Bill and I compliment him on the way in which he is receiving our amendments here today. The problem is that some of us, and I include myself in this, are extremely happy with the Minister's handling of the Department of Health, but there are people out there——

Obviously Senator Honan was not listening to me. Some are not so gifted as others with appreciation of good administration. We have no assurance that people like Senator Honan and others may not some day play a role in displacing the Minister and installing somebody else in whom we might not have the same confidence. Whereas we can take ministerial assurances on this point, unfortunately our job here is to enact legislation which will guide the nursing profession through and give them a legal basis for the next half century, we hope. Bearing that in mind, I take up the Minister's suggestion in relation to section 9 (1) (d) (x) that "two shall be persons representative of the interest of the general public". I ask the Minister between now and Report Stage to consider an amendment for insertion in section 13 or in Part V of the Bill which will provide legislatively that one of these people will be on the fitness to practise committee.

I accept the Minister's point which he made by implication that this Bill in one sense parallels the Dentists Bill. That is true, but we get experience as we go along, and our job should be to produce the best legislation possible, not necessarily an exact model of what was produced in these Houses even 12 months ago. There is a need to have on the fitness to practise committee an element of independence, an element which can look in from the outside, as it were, and give the public an assurance that the complaints they are making are not being adjudicated purely from within.

If I may draw an analogy, one of the complaints frequently made about the old Land Commissioners who adjudicated on the taking of land from farmers in the west was that the commissioners were in effect Land Commission officials. Frequently I heard legal colleagues saying of that old procedure that it was a little like going to law with the devil and the court being in hell. The same could be said about a complaint to the Nursing Board; it is a little like going to law with the devil and the court being in hell. Once again the people who will be dealing with a complaint are all members of the nursing board. What the Minister said — very eloquently and I am not suggesting that he is trying to mislead the House — about the 12 people not necessarily being nurses is not true. Of the 12 people appointed by him under section 9 (1) (d) the majority could very well be nurses. "One person representative of the management of health boards" could be a nurse. Even the two who represent the interests of the general public possibly could also be nurses. It is not spelled into the Bill apart from the phrase "qualified nurses". It is not specifically exclusionary in that respect.

I feel strongly on this point. To protect the public and above all to protect the nursing profession, this Bill is intended to provide for the nursing profession as such and to provide for the establishment of the Nursing Board for their registration, control and education. The best protection the Minister can give them is to create a situation where no member of the public can ever say in relation to a complaint about nurses that it is being dealt with purely from the inside. The best protection and the best guarantee we can give them against unfair complaint is to allow it to be said that on their fitness to practise committee there is a fair proportion of independence and something for somebody from outside the Nursing Board.

I accept the point the Minister made but I ask him to look at this point very seriously between now and Report Stage. I make that point in the light that the nursing profession will increasingly come under pressure from the public in relation to allegations of negligence, allegations of misconduct and allegations of breach of professional practice. These allegations will not necessarily have any sound basis, but the move by the public towards professional interest is increasingly one of complaint. I am simply asking the Minister to protect the nursing profession against unfair complaint or, indeed, against unfair adjudication by the public of their fitness to practise procedure.

I cannot agree with Senator Durcan. He seems to think that by the inclusion of a person from outside the nursing profession, that person because he or she may not be a nurse will look after all our problems on the fitness to practise committee. I would have much more confidence in the composition of that committee and in the new members regardless of whether or not they were nurses. With due respect to Senator Durcan, he thinks that by just putting one person who is not a nurse on the fitness to practise committee we will have a person who may think differently and look after all our needs, but the committee from day one will be doing that. This is where I disagree with Senator Durcan.

I can partly understand his concern that the person elected may not know anything about nursing but will stand back and see things in a different light just as in the case made a while ago for a student nurse on the board. I would have much more confidence in the nurses who will be on this committee. I see no need for this person who never participated in their world at all to protect our interests. I totally agree with Senator Durcan on the importance of this legislation and the importance of this Bill, but I do not hold his views. I am not just disagreeing with Senator Durcan on party lines. I absolutely believe what I say. I do not share the concern of Senator Durcan about having an outsider put on to the fitness to practise committee to ensure that the nurses do what is right for all of us.

To follow through the point Senator Honan made, I made my point because I am aware first, that in the public mind in relation to the Law Society — a body of which I am a professional member — there is a belief that their procedure in dealing with complaints is unfair because the committees who deal with them are entirely composed of members. Secondly, I am aware that under the current Garda Síochána disciplinary regulations when a member of the Garda is brought before a disciplinary board — I have defended a dozen or more of them in a professional capacity before their own disciplinary tribunals — there is always the belief on the part of the member who is charged that he is not getting fair play even within his own professional body and there is also a belief on the part of the public who may lodge a complaint against a garda that they will not get fair play or that the matter will not be adjudicated properly because the board who deal with the complaint are entirely an inside board.

While I agree with many of the points which Senator Honan made I put down this amendment by way of protection of the nursing profession. I have discussed this with many nurses and their initial response is: "No, we do not want outside participation within our disciplinary procedure" but when it is explained why they should have outside participation most nurses accept that it is for their own protection.

By a lawyer.

Yes, by a lawyer and by a member of public. Indeed we are trying to make law here today and I hope we can make good law.

I make the broad point that there will be 12 persons appointed after the Minister has consulted with such bodies or organisations as he considers suitable. He will appoint 12 members other than the 17 elected nurses. The only commitment among the 12 is that one of them shall be a nurse. That commitment was put in in a very specific way largely to assess the specialities that would not be elected or would fail to be elected onto An Bord Altranais. That was the main purpose I had in mind in relation to that section but if one considers the other 11, one must be a general medical consultant in a training hospital, one must be a consultant psychiatric doctor in an approved hospital for the training of psychiatric nurses and one must be a registered medical practitioner at consultant level so far as I am concerned in the obstetrics area.

They are not nurses but no doubt they will become involved in fitness to practise issues which will arise, particularly in the light of their specialist knowledge. One shall be a member representative of the management of health boards. It is highly unlikely that I would be appointing a nurse in that area when we are talking about a large number of measures——

It would be at that level generally and one should be representative of management of hospitals, other than hospitals administered by health boards. There are a large number of board members of hospitals, secretary managers of hospitals and so on. It is unlikely that there would be nurses and so on down the field. There is every prospect that of the 11 non-nursing personnel — it is not spelt out that they be non-nurses — out of the 29, a number will finish up on fitness to practise disciplinary committees.

I share the Senator's concern about the situation in the Law Society. The present Council of the Law Society are composed as we know entirely of solicitors and these solicitors are an entirely self-statutory disciplinary committee. An analogy cannot be drawn with An Bord Altranais because, although the Law Society have expressed their willingness to have lay participation on the disciplinary committee, they have not accepted that there should be any lay participation on the council as such which is very different from An Board Altranais where there is substantial lay participation. Indeed, the Restrictive Practices Commission have recommended the inclusion of lay people on the council and I understand that the Department of Justice are considering making appropriate provision in the amending legislation for the Solicitors Act so I think the Senator's wishes will be fulfilled.

We are talking about fitness to practise.

Yes. The practise area is a very defined area and I appreciate that undoubtedly in the years ahead there will be more litigation surrounding medical care — nursing practice, medical practice and dental practice. There is bound to be more and more litigation. That is a growing phenomenon in all European countries, including Ireland. We have gone a long way in reforming An Bord Altranais to make sure that it is as broadly based as possible. The fitness to practise provisions are adequately covered. It is the public interest we are talking about. It is a counter-balancing interest: the rights of nurses versus the rights of patients and the public generally. There will be at least nine non-nursing personnel on the board. Regarding the third level educational establishment, the third level appointee is not specifically spelt out in this but that person will probably be a nurse because there are some very senior nursing personnel involved in third level education and training establishments. A representative of that area could be a nurse. Of the two representatives from the Department of Health one would be a nurse, I should think. There will be nine others out of 29 who will not be nurses so far as I am concerned.

That is an unfair construction. They do not necessarily have to be people who are not nurses. It is possible that some of the nine could be nurses. I cannot accept that they would all have to be people who were not nurses unless you specifically provide that they shall not be nurses.

I can assure the Senator that when I would be contacting the various bodies I would be very reluctant and very unlikely in the light of 17 elected members and the definite likelihood of another three from the nursing profession — 20 out of 29 — to accept in my consultations with the health boards and the hospitals that the person representing the management of health boards should not be a nurse. There is a large body of persons other than nurses who could be nominated. The same goes for the management of hospitals. If the name of a chief nursing officer is put before me by way of representation from those with whom I would consult I would be very ill-disposed to accepting that nomination. One would have enough with 20 out of 29 to keep a balance and the balance will be struck on that basis.

Surely Senator Durcan is happy that the Minister in his excellent judgment shall appoint persons who will represent the interests of the general public?

The Senator is missing the point. I know the Minister will exercise good judgment but in about ten years time we may have a different Minister.

The Senator need not worry about any Minister from our party:

Amendment, by leave, withdrawn.
Amendment No. 3 not moved.
Section 13 agreed to.
Section 14 agreed to.
SECTION 5.

I move amendment No. 4:

In page 11, subsection (1), line 15, after "order," to insert "after consultation with the Board,".

This section and this amendment are important. If the members refuse to carry out their functions, this section provides that the Minister may by order direct the board to discharge the function and for that purpose to do such other matters or things ancillary or incidental thereto that may be specified in the order. It would be far better if the Minister carried out this work after having consultations with the board and finding out what misdemeanours were present. It would be a reflection on the board to leave this section as it is drafted. It would be preferable if he accepts this amendment. That would be a fair way of dealing with this question and it would be a way of providing confidence in the board.

When I read this amendment first I was disposed towards it but the point is frequently overlooked that the section deals with the functions assigned to the board under the Act. This section has been unfairly construed by interests in the country who have suggested that the Minister might use power unfairly to deal with the Nursing Board. It is reasonable that the Minister should have power to remove the board from office if the board neglect, refuse or fail to perform the functions assigned to them under the Act. It does not deal with anything else that the board have to do. On the point being made by Senator Fallon I do not think any board should be removed from office by a Minister in the exercise of his statutory powers unless they are given an opportunity of exercising that which they have failed to do up to that point in time. An assurance should be given to the effect that before the powers under section 15 would be exercised the board would be given notice that unless they perform their statutory functions the Minister would exercise his powers under this section.

I think I can give that assurance but it would be very difficult to formally write the assurance into the Bill. The power given to the Minister of the day is entirely discretionary. Where 17 members are elected and 12 appointed in addition, then where a board refuse to perform or neglect to perform any functions specifically assigned to them under the Act, the Minister of the day should have power to remove them from office. That is a reasonable provision. It is highly unlikely that the Minister would indulge in such an action unless he took a number of steps. He would be in constant communication with the board prior to any such thing developing. To remove a board from office would require the Minister to bring the matter before the Government by way of a memorandum so that he would have the support of his Government colleagues. Failure on the part of the board to perform functions assigned to them under the Act would be a matter of public notoriety long before they would be removed from office. That would have hit the fan, so to speak, in a big way before the Minister by order would direct the board to discharge the function concerned.

The Minister would need to be on very good ground because he would have to put the order before the Houses of the Oireachtas. He could hardly act in a capricious or malicious manner because every order under the section shall be laid before each House of the Oireachtas and if a resolution annulling the order is passed within 21 sitting days, then it shall be annulled accordingly. So there will be a full scale public debate in both Houses of the Oireachtas before a Minister would finally have got away with it, so to speak, if he wanted to act in a precipitous manner towards the board. For these reasons I am reluctant to accept the amendment.

It stems largely from the fact that nursing legislation has not been changed in the country for 35 years. Then suddenly the profession and bodies associated with the profession do not realise that over the past 35 years our body of law has given the Houses of the Oireachtas, the Government and the Minister of the day certain basic statutory powers. If you give this authority to a board, on the other hand, there must be circumstances where you take it away. This has become a huge issue among people who had very little conception of legislation relating to the profession, very little awareness of the basic fundamentals of drafting a Bill and people wonder how can any Minister dare get rid of a board, that that is unthinkable.

Of course, if you give functions to a board and if the board fail to discharge their functions the Houses of the Oireachtas must have power to take the board out of existence. It is a logical sequence of statutory power. Section 15, therefore, is framed in that way and there is the double barrelled safeguard in section 15 (5) that every Member of this House could spend a long time debating it if a Minister dared to act in a foolish manner.

Suppose a situation did arise where the Minister would have to disband the board, would it not be much more advantageous from his point of view to be able to say to the Dáil at that time that he has had discussions and consultations with the board and if that is the case, would it not be as well to insert it in the Bill at this time?

It goes without saying because the inevitable outcome would be that if any Minister came before the Dáil and said that he had abolished An Bord Altranais and removed the members of the board from office, the first question he would have to answer would be what consultations he had had, what basic argument he had, if there had been exchanges of correspondence with the board, and all that would come out in the wash. Otherwise, no Minister would dare to do it. For that reason it is necessary to have it inserted formally. If a Minister failed to consult on this, he would be thrown out. At Government level where there are 15 wise men ——

Some wise men.

Invariably wise and always true.

The Minister is not even able to continue.

The Minister is at a loss for words.

Short shrift would be given to a Minister for Health who would try on anything like that.

I do not understand the Minister because if you consider section 54 (3), how is the Minister to go ahead without consent of the board? The Minister can remove the board from office and substitute somebody to carry out the work of the board even without a Dáil debate. Am I right or wrong on that? I have gone ahead now. We are dealing with section 15 and we will have to have this debate in the Dáil and Seanad.

Am I not right — to be sure that I have the position clear in my mind — in saying that if the board fail, refuse or neglect to do something or not to do something, the Minister must then make an order under subsection (1) directing the board to do or not to do, to perform or not to perform, and it is at that stage that the Minister can exercise his statutory powers in relation to the removal of the board from office. Is it the case that the Minister cannot remove the board from office until after he has given them the initial warning, the order under subsection (1)?

Yes, that is true. If the board, under section 15 (2), fail to comply with any direction of the Minister contained in an order made by him under subsection (1), then the Minister may, by order, remove from office the members of the board. There is a double-barrelled effect on the situation.

Is the amendment withdrawn?

Perhaps we should leave my query until we reach section 54 (3), because we are beginning to speak here about the power of the Minister. Maybe I am wrong or maybe the Minister would prefer to leave it until section 54 (3). Is section 54 (3) not very much like section 15 (5)?

Acting Chairman

Is the amendment withdrawn?

Amendment, by leave, withdrawn.
Section 15 agreed to.
SECTION 16.
Question proposed: "That section 16 stand part of the Bill".

I would like to make a point on section 16 (3). In the knowledge that the board and the nurses generally are going to fund the chief executive's salary, why then should there be an intrusion from time to time on the part of the Minister? Does the Minister think that this is necessary?

It is difficult to envisage a situation arising, particularly where there are 29 people involved, where a board so fail, neglect or refuse. It is difficult to imagine a situation where a board would become so obdurate that they would just refuse to carry out any function assigned to them under the Act. The functions of An Bord Altranais are very, very specific under the Act and it has to be one of those functions and no other function. The board will have their own legal advisers. They have power to engage their own legal advisers. They will be advising the board versus the Minister of the day as to whether they were acting in a totally obdurate manner towards the Minister of the day. But then if he is satisfied, having consulted — as I would have to — with the law agent of the Department of Health, he would draw up an order formally directing the board to implement their functions under section X of the Act and on failure to carry out that order within 21 days then dissolve the board by making another order. The Minister would have to put both orders before the Houses of the Oireachtas. At that stage the Minister would want to be on very, very firm ground and the board would want to have been taken over by a unique blend of people before you would get 29 persons with that kind of total conflict, before the situation would deteriorate to that extent. The section as framed is fair and reasonable. It has a double indemnity, if I may use those words.

The Minister is saying that it would be unlikely that you would get 29 people on a board who would, after consultation with their law agent, make the kind of decisions which would necessitate the abolition of the board. Why then is it necessary to have, right through the Bill, this almost conditioning process of doubt, as it were, as to the capacity of the board to carry out their functions? Would it not be better to allow them some greater freedom rather than have them hamstrung with these controls, which would appear to be very tight, having regard to the numbers that are on the board? I agree with the Minister that it is extremely unlikely, with all the representative interests that are involved, that these situations would arise. In other words, why is the Minister anticipating these difficulties in that way?

I would argue, largely because of the very large number of people concerned, namely, the thousands of registered nurses and the impact they have on the health services and their work and the seriousness of the issues involved, particularly fitness to practise with regard to education and training, that they are of such major importance that one has to have fairly tightly framed legislation similar to that of the medical and dental professions. Questions of professional misconduct arise, very serious issues involving the livelihoods of persons, their public integrity and their professional competence. For example, on one of the fitness to practise issues, alleged unfitness to practise such practice by reason of physical or mental disability, very major questions have to be decided.

In that light it is essential that it be very finely balanced legislation and that the board have their powers, but that the Minister for Health of the day should equally have, in a balanced way, the opportunity of representing the public interest with the Houses of the Oireachtas and the Government of the day. There seems to be a general concern that the Minister would have too many powers under this section. I would stress that section 15, in the light of 35 years of enactment of statutes through the Houses here, contains a standard provision. This is the standard provision and it is not exclusive to this Bill of itself. When I pointed out to a number of people that section 15 was simply a re-enactment of section 23 of the Nurses' Act, 1950, they were surprised, but we were going along perfectly happy for 35 years under this provision. It goes without saying that, before any order would be made under section 15, any Minister for Health would have to consult with the board to get their views. Indeed, it might be expected that the board would come to the Minister if they had reached such a stage of difficulty and said that they had an appalling problem, we would seek advice and guidance on it.

I have excellent relations with An Bord Altranais and down through the years relationships have been extremely good. I know of no good reason at the moment why, with the new board being set up — and it is hoped to have the new board set up in the very immediate future — these excellent relationships should not continue.

Section 16 (a) states:

The Chief Executive Officer shall be appointed by the Board and shall hold his office on such terms . . . .

Does the Minister never see a woman being appointed — and this is not my role at all here today? Should it not be "his or her office"?

I would certainly wish to see women appointed as chief executive officers of a number of bodies, including health boards. It might not be any harm at all.

They would do a lot of good in some respects.

Only in some respects.

It is purely a matter of interpretation under the Interpretation Act. If I may quote the parliamentary draftsmen, "he" embraces "she" when it comes to legislation.

Question put and agreed to.
SECTION 17.
Question proposed: "That section 17 stand part of the Bill."

A point was raised previously, perhaps by Senator Smith, regarding the unnecessary power, if you like, that the Minister has taken upon himself in this section not being wanted, in this section at least. Certainly, I accept there has to be ministerial control on many occasions and in many Bills but I am wondering if it is necessary to have the consent of the Minister from time to time as outlined in section 17 (1). To repeat myself, the use of ministerial power in this section is again unnecessary.

The payments outlined in section 17 (3) have to have the approval of the Minister for Health. I paid very close attention to the Dentists Bill when it went through this House and there we had to have the approval of the Minister for the Public Service also, if I recall. Perhaps the Minister would tell me if I am wrong. Do we have to have the approval of two Ministers here? We are going to need the approval of four Ministers in regard to the National Development Corporation. Are we really talking about the approval of two Ministers in section 17, or is it only the approval of one Minister? I support Senator Fallon on the power of the Minister, but I have to be careful about using those words. Is there a Minister involved in the working of section 17 other than the Minister for Health? If I recall correctly in a certain section of the Dentists Bill, the Minister for the Public Service as well as the Minister for Health was involved.

I agree with the point Senator Fallon made in relation to subsection (4) of section 17 of this Bill. It is unreasonable that the Minister should retain statutorily the power that he retains under subsection (4). That is the power which provides that the board or the chief executive should not appoint certain officers or officials of the board if the Minister is not happy with them. That is a very unreasonable power, bearing in mind that we are trying to establish an independent nursing board, with certain safeguards which I have been speaking about here all day, but not getting very far. The most important safeguard of all is the safeguard conferred by section 15. That gives the Minister very substantial powers to remove the board if they fail, neglect or refuse to perform their statutory functions. That should be sufficient control over the nursing board. We are establishing an independent body to do an independent job and to do it in a professional manner on a proper statutory basis. If they do not do the job, the Minister can, under section 15, order them to do it and if they neglect, refuse or fail he can then remove them from office. But to add in the additional power which is provided for in subsection (4) of section 17 is, to say the least, absolutely unreasonable. It is unreasonable that the board should be subject to such ministerial control in relation to the appointment of a chief executive officer or, indeed, to the appointment of other officers or employees of the board. It is a totally unreasonable power and it is something which I would ask the Minister to consider seriously between now and Report Stage. If he can abide by what appear to be the wishes of three Members of this House, then I would ask him to consider introducing an amendment to delete subsection (4). There may be good reasons for this subsection and I would like to hear the Minister on it.

I would like to ask the Minister why he has this worry, as Minister for Health, that he has to take this kind of power? Here — without being at all political — I would be as concerned about the Minister's successor or successors as himself. Why is the Minister seeking this type of power? Our only chance with this serious legislation, as Senator Durcan said, is to absolutely trust the new Bord Altranais from its inception. Section 15 affords a good deal of power to the Minister. Therefore does the Minister really have to have this power over their heads? There is very strong language in section 17 (4).

One of the chief reasons is to give basic protection, not just to the Minister of the day, but also to the chief executive officer, remembering that the chief executive officer is appointed by the board and shall hold office on such terms and conditions as laid down by the board with the consent of the Minister, as the board determines. We have known of many situations in which chief executive officers are in grievous conflict with the board of a particular body. This can be an appalling problem — where civil war breaks out between a CEO and the board who have appointed him. The prospects of arbitration or of influencing the course of events are nil unless the Minister has authority. This country has become a very introverted society where everybody watches their perennial rights in a very personalised way. It is essential, if a Minister is to exercise or influence the course of events, that he should have authority to declare that any power conferred on the board by this section shall be exercisable with the consent of the Minister only or that, whenever such declaration is enforced, that it be given only with his consent. He should have authority to do that. It is as much a protective mechanism as the influencing of the role of a board. It is a standard provision. The powers are not that wide ranging. In the Dáil I did amend subsection (5). We have changed it quite considerably from the original head of the Bill, as envisaged, and the all-embracing power that it gave both to the Department of the Public Service and to the Minister. It has been carefully amended.

I might also make a broad point here about An Bord Altranais. There is no interference in the day to day operation of An Bord Altranais by the Department of Health. We have a very close relationship. When a board is set up it is given authority to go ahead and do its job. We have a very small Department, employing approximately 360 people, specialist public servants. The section looking after the day to day operations of An Bord Altranais is a very small one. That is why we devolve on the board as much power as possible. But, in the heel of the hunt, if a bad row develops, there must be Ministerial statutory authority to become reinvolved. There is a difficulty here in that we have not had amending legislation since 1950. Therefore this provision is very much a standard statutory provision. There is nothing exceptional about it. I do not think that the current chief executive officer of An Bord Altranais would be unduly perturbed about it. It also gives him protection. He can appeal to the Minister of the day if he is in glorious conflict with his board. He has the opportunity of saying to the Minister "Look, I must be protected"— and the Minister, of course has the power of intervention. That is essential and is not draconian in any way.

I accept what the Minister has said. He clarified the situation in relation to a problem which may exist within a board where a chief executive officer may get into difficulties with his board, when the board may want one thing and the chief executive officer may want another. In relation to the appointment of officers or servants to the board under section 17, I can see that. Am I right in saying that the power can go beyond that? Can it also be used where a Minister or his officials, for any number of reasons which might not have anything to do with any differences of opinion as between a CEO and a board, may decide that a particular appointment is unwise? Am I not right in saying then that the Minister may then completely overrule the views of the board and of the chief executive officer, go ahead under subsection (4) and refuse to appoint, unless with his consent?

That is true, yes; there is still a residual authority devolved on the Minister. I do not think we have reached a stage of bureaucracy here in which the Minister is going to finish up running An Bord Altranais. After all, with 17 elected members and 12 additional members appointed, the board will do its day to day work. It will present the Minister with an annual report and accounts, and liaise with the departmental staff on a regular administrative basis. But I can assure Senators that a Minister for Health and Social Welfare has more onerous ongoing policy obligations devolving on him every day without prying into the day to day operations of a particular board. A Minister would need to become a total egomaniac if he were to try to take over the running of every board under the Department of Health. There are so many of them that one loses track of them now and again. The provision is very much a matter of advice and guidance by the parliamentary draftsman.

A situation can arise in which a CEO is at total loggerheads with the board. On the other hand, the Department may be at loggerheads with the CEO and the board itself. In those circumstances the Minister has to declare that the power will be exercisable only with the consent of the Minister. That very difficult situation can develop. For example, it could develop in terms of public service pay. Some boards might decide to pay a CEO a particular salary scale which would be unacceptable to the Minister because he would have the overall remit of consultation with the Minister for the Public Service about setting the conditions of pay, salary and expenses. They may decide to do something quite unusual. It is not unknown. I see it happen every day of the week when these anomalies suddenly emerge. I have very little hair on the top of my head but what little I have stands up when I see some of the decisions of some boards in that regard——

The Minister might see more of them.

——when one has to intervene and say that that is totally out of the question. I have to tell them "There is no way the Government of the day could stand over that particular decision and, if you propose to do that, we will have to invoke section X of the Act."

Question put and agreed to.
Sections 18 and 19 agreed to.
SECTION 20.

I move amendment No. 5:

In page 12, to delete lines 41 to 50 and in page 13 to delete lines 1 to 8 and substitute the following:—

"20.—(1) Where a person who is either an officer or servant of the Board is—

(a) nominated as a member of Seanad Éireann or as a candidate for election to Dáil Éireann or to the Assembly of the European Communities,

(b) elected as a member of Seanad Éireann, or

(c) regarded pursuant to section 15 (inserted by the European Assembly Elections, Act, 1984) of the European Assembly Elections Act, 1977, as having been elected to the Assembly of the European Communities to fill a vacancy,

he shall stand seconded from employment by the Board and shall not be paid by, or be entitled to receive from, the Board any remuneration or allowances—

(i) in case he is nominated as a member of, or elected to Seanad Éireann or is so elected to the Assembly of the European Communities, in respect of the period commencing on such nomination or election to Seanad Éireann or such election to the Assembly of the European Communities, as the case may be, and ending when he ceases to be a member of Seanad Éireann or that Assembly,

(ii) in case he is nominated as a candidate for election to Dáil Éireann or to the Assembly of the European Communities, in respect of the period commencing on his nomination and ending when he ceases to be a member of Dáil Éireann or that Assembly, as the case may be, or fails to be elected or withdraws his candidature, as may be appropriate."

The purpose of this amendment is to bring the Nurses Bill, 1984 into line in so far as this matter is concerned with the Dentists Act. On reading through the Bill, as presented to the Dáil, and as subsequently passed by the Dáil after much debate, I was surprised to note that section 20 had not been amended and the parliamentary draftsman had, willy-nilly, followed the wording of the section, which was originally inserted in the best of spirits, when it came before both Houses of the Oireachtas. The Dentists Bill was initiated in this House. Senator Dooge moved an amendment to that Bill principally for the purpose of removing the difficulty which persons who are nominated to the Seanad can encounter in relation to situations of this nature.

I might quote from the Official Report of 27 June 1984, volume 104, column 532, where Senator Dooge stated:

It is the view both of Ministers who have spoken here in the House and of Senators that this is a general matter and should be tackled by the amendment of the Seanad Electoral Acts. It appears to me that a simple amendment of section 27 subsection (2) (c) of the Seanad Electoral Panel Members Act, 1947, would remove this matter from the debate of this House forever, rather than having it as something that recurs every two or three months.

We have put forward this amendment because it is now the view of all groups in this House that the Seanad cannot continue merely to raise this matter and then receive assurances of Ministers and then have the matters sink back into neglect again.

The matter is one that can arise when people, without their prior consent, are nominated to contest Seanad elections. Indeed, as Senator Dooge pointed out when moving the amendment to the Dentists Bill, the matter was highlighted in the case of Deputy Taylor-Quinn who found herself nominated by the Irish Dental Association, subsequently sought an Oireachtas nomination and found, following a decision of the judicial referee, that she was not able to withdraw from the outside body nomination. In other words, somebody could be nominated, without their consent, and be caught in such a situation.

During the debate on the Dentists Bill the Minister in the course of his remarks contained in the Official Report, volume 104, column 535 had this to say:

I can confirm that the matter has been raised and discussed in some detail at Government. It was agreed on an informal basis at Government that the Minister for the Environment and the other appropriate Ministers should review the question of members of boards and officers and — if I may use the out-dated term — servants of boards, being barred on nomination for election to the Seanad even though the nomination is without their consent. Admittedly, the amendment now offered is relatively restrictive. However, it is acceptable to me. It is time that we created a precedent.

Those were the Minister's words in this House when he agreed to an amendment proposing — to the Dentists Bill. I would ask the Minister fo follow the precedent here today to which he referred in this House on 27 June 1984.

I am prepared to examine the amendment. I would ask for some time between now and Report Stage as to how best we might come to grips with this because we are referring to both members and staff involved. I gather the purpose of the amendment is to protect the employment of an officer or servant of the board who is nominated as a candidate for election to Seanad Éireann. It is correct to say, as the Senator has already pointed out, that there is the reality that the Dentists Act now has the force of the amendment proposed because I did accept that amendment in this House previously. However, I should like to examine the exact text, as proposed by the Senator, and consult with him prior to Report Stage with a view to dealing with the matter. I have a difficulty in that once again it would have to go back to the Dáil if amended here and we would have to find an opportunity in the Dáil to deal with the matter. As the Senator is aware, this Bill has been with the Houses of the Oireachtas for approximately 17 to 18 months. It was during the course of that period that the Dentists Bill came up. Finally, the Senator's concern is in general related to board members, not staff members of boards. The Bord Altranais provision relates to staff only. I should like to have a look at the matter between now and Report Stage and consult with the Senator in the interim. I would be obliged also to consult with the Minister for the Public Service because it would mean amending the Bill as originally approved by Government and as approved by Dáil Éireann.

I accept what the Minister says and on that basis I will withdraw the amendment on the understanding that I shall have an opportunity of putting down a similar amendment, or a satisfactory one proposed by the Minister, on Report Stage. I do not want to use a word as harsh as "resent" but the fact that this Bill has to go back to the Dáil should not constitute an excuse. Both Houses of the Oireachtas have equal standing constitutionally. The fact that the Dáil does not find defects in legislation, accepted previously by both Houses is no reason why something should not go back to the Dáil to be corrected. I would be surprised if that was advanced as the reason this amendment would not be accepted. I feel sure Senators on all sides of the House would share my view on that.

I proposed the amendment for the purpose of making this legislation the best possible legislation to be produced by the two Houses of the Oireachtas. The Minister was very open in accepting amendments to the Dentists Bill, when we had the best parliamentary debate I experienced in my 2½ years here. I hope the Minister will be equally open in accepting this amendment to this Bill even though it necessitates the inconvenience of having to go back to the other House.

I accept the stricture of the Senator in regard to the fact that the Bill would have to go back to the Dáil. The only matter which concerned me there was the consequential delay in the holding of elections to the new board because we are moving towards the end of the year and it is a matter of trying to find an appropriate slot for electoral purposes. This is the only reason. I can assure the Senator there was no other intention in my mind.

I should like to support the mover of this amendment. It is important that we should canvass the widest possible candidature for representation. We should try to eliminate, wherever possible, the various obstacles that might be put in the way of such representation. This amendment addresses itself to that point. As a member of a para-nursing profession certainly I did not suffer the conditions contained in the Bill, as printed, in order to be standing here speaking as I am now.

Amendment, by leave, withdrawn.
Section 20 agreed to.
Sections 21 to 24, inclusive, agreed to.
SECTION 25.

I move amendment No. 6:

In page 14, between lines 19 and 20, to insert the following subsection:—

"(2) Whenever it may be found necessary by the board to increase a fee under this section such increase shall not exceed the percentage increase in nurses' salaries in the preceding year or years (as the case may be) to which the increase is made."

Many nurses I have spoken to are concerned and have expressed the view that in a few years time they will be paying 20 per cent or more of their salary in fees to the Nursing Board. This amendment is fair because it will ensure that there will be a control on any increase in the annual retention fee and that that percentage fee shall be as the amendment states. It is a very fair and reasonable amendment. It will ease the worries of many nurses and I ask the Minister to give very serious consideration to it.

In relation to the amendment and in relation to the section one of the comments made by many nurses who spoke to me about this Bill showed their apparent resentment at having to pay a fee for the various matters specified in this section. I want to put on the record what I said to those nurses, namely, that it is reasonable that members of any profession should be charged a fee for the matters specified in this section so I do not agree with the points which many nurses have made.

In relation to the amendment, I do not altogether agree that you can relate a registration increase strictly to the salaries of nurses because salaries of nurses, under certain circumstances, may differ. They are not all in the public sector. Some are employed outside the public sector and it would be very difficult to relate registration increases.

I would be more concerned about the nature of the register that is maintained. The information I have suggests that there is in existence simply a register of all nurses who qualified, going back to the legislation of the early part of this century. I do not know if that is correct but that is the impression I garnered from the nurses I have spoken to and from the many representations I have received in relation to this Bill. In other words, the point has been made to me that there is no live register of practising nurses. If that is the case then I ask the Minister, within the ambit of this Bill, by regulation of ministerial order, or in the exercise of one of the many powers which we are told by various people that he has under this Act, to regulate and to ensure that a live register is maintained of all nurses currently in practice.

Secondly I would like the Minister to ensure that the register is divided into the various types of nursing practices, in other words, that a nurse could deem herself to be registered under the heading of a public health nurse, a psychiatric nurse, or as a nurse in one of various other types of activity, when I say that the register should give a particular specification to a nurse as to her preferred type of practice or her operational type of practice. I do not think any additional fees should be charged in respect of an individual who would be on more than one nursing register. There should be a particular categorisation for all nurses and there should be a live register. If that is not done it will be extremely difficult to maintain control over the nursing profession and it will be very difficult for the public to maintain a check and balance in relation to the profession. The existence of a live register is of paramount importance and I would like the Minister to assure the House that such a live register can be brought into existence at the earliest possible date.

I do not think anybody was too clear on this section when it was passed in the Dáil, with due respect to everybody there. I understand there are many fees. The nurses are not objecting to a fee but they are worried — and they have reason to be — that we might recommend a fee of £5 or £10 now and a fee per qualification plus an increase in the said fees per qualification so that nurses in a few years time — and the Minister has put much emphasis on the years ahead — could find themselves paying a registration fee of something colossal like £100. It is hoped, whether it is paid annually or less frequently, that it could be kept to a realistic figure and to a percentage — not more than a percentage — of the increase in salaries of nurses during the previous year.

At one stage section 25, where these fees are dealt with, was unacceptable. The maintenance of the live register should be a function of the board and there should be sufficient moneys available from other fees to maintain the live register. The main worry, according to the nurses I have talked to, is about a fee per qualification. They are not objecting to paying a fee. They have good reason to be worried about the level of fees in the years ahead as a result of this legislation and as a result of recent charges in other places.

The concept of a registration fee where professions gain further control in the management of their own affairs is not disputed. It is quite a healthy development and obtains in a number of other professions. However, I would like to make the point to the Minister that, as he well knows, as a result of the cutbacks in the health services a considerable number of part time nurses have lost their opportunity of employment. Therefore, a number of people in the nursing profession do not have the opportunity to work. Obviously they would want to remain registered in order to avail of employment opportunities that might arise. Has the Minister given any consideration to having a somewhat easier regime for people who find themselves in those categories?

I support and endorse what was said by the two previous contributors, Senator Smith and Senator Honan. Nurses are not well paid. Employment for nurses fluctuates and, as has been pointed out, many nurses are part time because of their commitment to the home. It would be very wise to introduce an amendment stating that the fee should not be increased by more than the percentage increase in a nurse's salary. Consideration should also be given to part time or unemployed nurses. It might be tied up with some obligation in regard to refresher course activity at the point of re-entry or, in the case of the part time nurse, a certain obligation to participate in refresher courses every so often. We understand that one of the points about registration is to ensure that standards are maintained and that those who are responsible to see that they are maintained have the resources with which to do so.

It would be quite wrong, particularly at this time of runaway inflation, to imagine that it would be possible to keep the registration fee in control unless some amending clause, along the lines proposed, is brought into the body of the Bill. I, therefore, conclude by mentioning that there seem to be three categories, the nurse who is in full time employment, the nurse who is in part time employment and the nurse who is unemployed. We should consider the registration fee in relation to the three categories and we might tie up, for the purposes of our own protection, the problem of the unemployed and indeed the part time nurse through obligatory refresher courses.

I regret that I am not in a position to accept the amendment. I accept, nevertheless, that control must be exercised in determining the levels of fees to be struck, that is, the level for each type of fee chargeable under this section and, of course, provision must be made for increasing these fees when necessary. On a general basis the consent of the Minister for Health is called for in the initial fee to be determined and any later increase proposed will have to be subject to the approval of the National Prices Commission. In addition, it will have to be subject to the consent of the Minister for Health of the day. These two conditions, the NPC and the sanction of effectively the Department and the Minister for Health apply to all fees that may be charged by the board.

It is unlikely that exhorbitant charges will be imposed on nurses. For example, the fee for the final exam at the moment is £55 and that for the post graduate exam is £55. They are pretty minimal and it is no imposition on any nurse to pay those fees. The registration of a student fee is only £10 which, in terms of the profession being really serious about its educational and professional standards, is a bit of a joke. My ambition is to meet the wishes of nurses. They want on the one hand a self regulatory profession which would be self disciplining and self developing in terms of educational post graduate work and so on but, at the same time — it is the old story of contradiction and self contradiction in Ireland and we are past masters at it — nobody wants to pay for the resources to provide that particular enhancement of the profession. It is endemic in our society that somebody else must pay. I am very pleased that Senator Fallon accepts the principle of a fee for the retention of person's name on the register. This is a new enabling provision without which it would be quite difficult to imagine any kind of a live register. The current nurse register is a joke. Ask any CEO taking on the employment of a nurse. He has to plough through the register to find out where that person is by virtue of——

He does not do the ploughing.

He has to pay people a substantial £X per hour to do it and that is taxpayers' money as well. We have a current register which is neither dead nor alive. It is a register of thousands of names. People have ceased to practise as nurses, have emigrated or died and there are out of date addresses. I marvel at the tolerance and capacity of An Bord Altranais in dealing with that situation.

Having a series of fees, for example, for the retention of the name of a person on the register is very basic. Any trade union member or any other profession would normally pay an annual fee to keep his name live on the register. That is essential and when it comes into force it will be of considerable importance. An Bord Altranais should provide above all more training opportunities for nurses who are already qualified and, despite the outstanding calibre of Irish nursing staffs, post registration training opportunities are minimal. It is questionable whether the skills have been retained in many instances with the high degree of immobility within our nursing structures whereby a nurse frequently stays in one hospital for a long number of years and her capacity does not expand. Above all, when so many persons either aspire to become nurses or are nurses, we have virtually no data on — if I may use the sexist term for want of a better one — manpower planning. These moneys will go in that direction to develop it and equally the money will go towards streamlining the selection procedures of students. It will streamline the current examination system and overall will give a higher professional standing. I am pleased that the House generally accepts the principle of a retention fee.

I assure Senators that there will be no question of major impositions and changes of fees without in the first instance the reference to the National Prices Commission which covers those charges. That is not in the Bill but it comes under the statutes relating to the National Prices Commission and of course it will have to be subject to the consent of the Minister for Health who is not likely to bring the wrath of the nurses on his head in regard to approving exceptional increases.

Equally as regards part-time and unemployed nurses, I assure Senators that there is power devolved on the board to, for example, agree that a person could come off the register for a specific period and go back on without charging a fee. Very considerable power devolves on the board to structure their fees in that way. During the course of the debate in Dáil Éireann I assured Deputies — and I want to repeat the assurance to Senators — that I will be asking An Bord Altranais to make that kind of flexible arrangement for part time nurses. A nurse might decide to give up nursing for three or four years. She would be kept on the register and would not be charged a fee during that period. The board have power to do this and I would encourage that reasonable development in terms of registration. That is the overall import of the matters raised by Senators at this stage.

I want to understand the Minister perfectly on the question of unemployed nurses. I know he referred to nurses who may opt in and out of the service because of their own situation. I would be more worried about people who do not have the option, who really want to be employed and who do not have the opportunity. Am I to understand that they could be on the register without paying a fee?

Yes; it is the general intention that they should have that prospect.

It is covered in section——?

The first line of section 25 says that the board may charge such fees for the registration of a person in the register. That is so flexible that I am assured by the board and the Department — and it certainly appears to me and the parliamentary draftsman — that the contingency which the Senator raised is included in the fee. It could be the registration of a person for a specific period or the non-registration up to a particular period. If a nurse is not engaged in the practice of nursing she may not have to pay. The board is happy enough with it as it stands.

I accept the Minister's assurance.

Acting Chairman

Is the amendment withdrawn?

Amendment put and declared lost.
Section 25 agreed to.
Sections 26 to 33, inclusive, agreed to.
SECTION 34.

Acting Chairman

Amendment No. 7 is in the name of Senator Fallon. Amendment No. 8 is consequential. Amendments Nos. 7 and 8 may be discussed together.

I move amendment No. 7:

In page 17, subsection (5), line 17, to delete "Minister" and substitute "High Court".

It is reasonable to have an amendment of this type inserted in this section. It is a Department of Health Bill and the input of the Minister for Health is all too obvious. Because of the Minister's involvement in it, that he has nominees on the board and obviously he will be au fait with the development of the nursing board and so on, he will be in touch with them and will be meeting them from time to time, I would feel happier if any appeals were to be made that they should be made to a High Court or a court at some level and not to the Minister. For that reason we have submitted this amendment. It is one that the nursing profession would welcome because the section as it reads says:

A hospital or an institution of which the Board has refused to approve may apply to the Minister to direct the Board to approve of it and if the Minister, after consideration of the facts of the case, gives the direction, the Board shall approve of the hospital or institution.

Simply because of the obvious intervention and control that the Minister has in regard to many of the sections of the Bill it would seem fairer that any appeals of this kind should be made to somebody other than the Minister and the obvious area would be the High Court. That is an amendment that should be agreed.

I was surprised both in Dáil Éireann and to an extent in this House at the reaction there has been to this subsection. The whole section, with the exception of subsection (3), is a reenactment of section 35 of the Nurses Act, 1950. That Act has stood the test of time and has not caused any embarrassment whatsoever to An Bord Altranais in all those years. I know that the board sets down quite stringent stipulations and standards for training schools and I stress this to our colleagues here. This is where an application is made by a hospital or an institution for acceptance as a training school in the first instance and where approval is being sought from the board for acceptance of the hospital or institution for such training. The hospitals either meet those standards and are accepted as training schools or they do not meet them and are then rejected as training schools.

Where a hospital makes such an application and where An Bord Altranais spell out to the hospital what they consider to be deficiencies in that hospital in terms of its prospects of being recognised as a training school, they are usually very specific in terms of the deficiencies and the hospital is left in no doubt whatsoever about its shortcomings in terms of prospective acceptance as a training school. Either it corrects those shortcomings if possible, or it accepts that it is just not able to come up to the standards of a training school.

There is included under the old legislation a provision in the interest of an appeal. There must be some system of appeal and I have included a right of appeal to the Minister for Health in the event of the hospital or institution feeling that it has been dealt with very unfairly by the board. That provision is there because within the Department of Health, and outside the Department of Health, the Minister may call upon independent hospital nursing experts to assist him in considering whether there is merit in an appeal or whether the board were justified in refusing to approve a hospital as a training school. The Minister may go back to the board. The board may subsequently decide to either accept that the hospital has improved its standards or that its original assessment was wrong. There has to be in all of our legislation a system of appeal.

Finally, I do not think there is a real need for the amendment. After it has been turned down by the board and the Minister for Health any hospital may decide to appeal to the courts anyway in the interest of natural justice and fair play and in the interest of getting accepted as a training school. It would still have that residual right. That right is not enshrined in the legislation but it is there as part of the natural process of appeal. What is proposed in the amendment is not in practice precluded. Presumably an appeal could be made to the court if the appeal to the Minister for Health failed to secure reversal of the board's decision.

However, I stress that in respect of new applications if An Bord Altranais say to a hospital that the level of its nurse training prospects are so bad there is no way they could give it approval as a training school, or the level of competence of nurse tutors is so abysmally poor that they could not give approval then most hospitals would run 1,000 miles rather than become involved in a major controversy of that nature. They would work might and main to improve their standards in order to get approval. That is basically the situation. There is not, therefore, a need for the High Court. It is difficult to know what the High Court could do in any event because they could only call in a panel of nurse educational tutors and experts to see whether the assessment originally made by the professional body was fair and reasonable. There are circumstances where one could envisage that situation developing, particularly where people set up their own hospitals, where they wished to develop their own empire, to get it approved as a major hospital and have their own training system inside and so on. These people might try to cajole An Bord Altranais to be registered as an approved training school. However, care is taken in section 34 not to permit that kind of situation.

Is the amendment withdrawn?

Amendment put and declared lost.
Amendment No. 8 not moved.
Section 34 agreed to.
SECTION 35.

Amendment No. 9 is in the name of Senator Fallon. Amendment No. 10 is consequential. Amendment Nos. 9 and 10 may be discussed together.

I move amendment No. 9:

In page 17, subsection (2), line 26, after "nurse" to insert ",but the training schools shall select their own candidates for Nurses Training."

This amendment has caused some controversy with the nursing profession and with the training schools in particular. The section reads:

The Board may, if it so determines, establish a central applications bureau to process applications from persons wishing to undertake training as a nurse.

In this section the formation of a central applications bureau seems to be reasonable and fair and something I would not quibble about. Having said that, I would also make the point that in regard to the Central Applications Bureau in the area of the university education there are many young men and women who cannot be very happy with the outcome of their deliberations from that area this year having regard to the leaving certificate results. Many people have been given positions they would prefer not to be given and they may find themselves in future occupations they have no flair for or in which they have no desire to be engaged. That is the way it is and there is some element of concern in that regard.

Here we are talking about a central applications bureau where each nursing applicant will apply to the bureau and it would seem the training school will not have the right to select. Here the trainee nurse will basically be an employee and the training school will be an employer. Because that employee-employer situation is totally different from the student situation I referred to earlier, it is important that there should be some level of input on the part of the training schools into the selection of the trainee nurses. It is wrong that trainee nurses should be sent to training schools without the training schools having some input or some opportunity to discuss with the trainee nurse their attitude to nursing and their attitude to the career generally.

Of all the professions nursing is one where interviews and discussions are necessary because you could have a situation where a young girl with excellent certificate results may wish to be a nurse but has no flair for the job. On the other hand, somebody with less favourable examination results might come across better in an interview with the appropriate authority. It is only right that this section should be discussed. We pride ourselves that our nurses are so excellent, so concerned and so good with patients generally, in all areas whether psychiatric, geriatric or whatever. That level of expertise has come about because the training schools themselves decided whom they should take into their training schools, they decided who would be best suitable to be trainee nurses and subsequently to be nurses. Because our training schools have had the input in the past, the level of expertise in the nursing profession is really excellent and this has been recognised.

This amendment is important. It is right that the training schools should have a major input into the selection of the trainee nurses and I think this amendment is one that the training schools would welcome. I hope the Minister will agree with my views on this matter. Past experience in the area of nursing and trainee nursing generally has been so excellent because of the manner in which it was handled. I see no reason to change the system whereby the training schools shall not have an input and shall not select their own candidates for nursing training.

The central applications bureau seems to be generally accepted by everybody. I ask why change something that has given us service, that has turned out nurses whom we praise and boast about when it suits us? I believe that the central applications bureau is to be accepted by the majority of my colleagues. I do not accept that the individual hospitals and their top team or their personnel would not have an input and could not dictate in some way to the nurses they would take into their hospitals. Certainly, there have been some persons who should never have gone into hospitals but there are people who should never have come in here and there are people who should never have become teachers and we all know the results of that.

What about Ministers?

The Ministers are included also.

Senator Smith should realise that the Senator is quite capable of looking after herself.

Senator Smith is aware of that. If the majority of my colleagues here, and in the other House, and the Minister for Health, want a central applications bureau why change a system that has worked well? The panels which have interviewed nurses down the years have given us the nurses who are in the wards this evening. I can accept that one worry the Minister may have and all elected persons have it, is about the hassle of a woman or man in our mental hospitals applying to five hospitals for a place but that is the reality of the nonsense that is going on. Hospitals must have a say in who they want to train and let into their wards.

This provision could have a far greater consequences than we think. We could finish up with the wrong people doing the interviewing and deciding who should be trained. I hope I will be proved wrong but certainly some very good nurses, with no political ties, have asked that the selection should be the exclusive function of the individual training school. This has worked well and I wonder why this was changed — God knows we are doing a lot of changing these days — when it has stood the nation well.

I understand the hassle and the cost involved where unfortunate students apply to five places and I accept that the Minister is trying to protect those young leaving certificate students from that cost but the individual training schools and hospitals should be allowed to decide who they take into their wards. I will name the hospitals if anybody wants me to — I do not pull any punches — and we will see how they stand. Some of the big hospitals in Dublin, and the majority of nurses working in wards in them as we put this legislation through here, are evidence of how the old system worked.

From time to time I have advocated decentralisation programmes, not just the transfer of personnel to different parts of the country, but also the decision-making process as far as possible. I shudder at the way Government systems over the years are being cluttered up. With the best will in the world on the part of civil servants and, indeed, Ministers, too many minute proposals reach a Minister's desk from time to time for a decision instead of him having a broader opportunity to deal with major policy matters.

For that reason I am extremely reluctant to support a centrally controlled bureau for recruitment of nurses. I am reluctant to support further centralised management but I have to admit, however, that appalling senseless trucking goes on with individuals, many of whom cannot afford it, getting trains or trying to arrange transport to interviews all over the country. Some applying to as many as nine or ten hospitals. We need to see an end to that and to the extent that a central applications bureau will eliminate some of that it has to be welcomed.

However, I support Senator Honan and Senator Fallon, who are trying to ensure that a significant input is maintained by the individual hospitals. I do that because far too often we seem to want to apply, right across the country in a lot of the systems, the same kind of notion even though different regions have different problems. Each hospital has its own personality and this should always be expressed in the staffing and in the way they manage their affairs. It would be difficult to twin the two and have the best of both worlds but it is not beyond the capacity of the Minister, and his staff, who exercise so much control and power in the Bill, to come up with a solution which provides us with a central applications bureau and at the same time ensure that there is a continuing and significant input from the hospitals as far as recruitment of trainee nurses is concerned.

I agree with many of the points that have been made by other Senators in relation to this section. There are just two points I should like to make. Firstly, the idea of a central applications bureau to process applications for persons wishing to train as nurses is a good idea. I agree with Senator Smith that the traipsing around the country of many people desiring to gain admission to the nursing profession is appalling. Not only is it expensive but it is also degrading. The fact that a central applications bureau may be established does not necessarily suggest to me centralisation as opposed to decentralisation. I see the central applications bureau, if it is established, operating on the basis whereby they would interview candidates right around the country at, say, county head locations.

Leaving aside that general point what worries me is the actual section. Subsection (1) says that the board may determine the minimum educational requirements and subsection (2) says that the board may, if it so determines, establish a central applications bureau. There is no obligation on the board to do any of those things. The powers which this section confer are absolutely discretionary and I am led to ask myself is this section, as drafted or as it appears in the Bill before us, necessary. Does it improve the Bill? I am compelled to feel that it does not. I do not think that the position would be any worse if this section was not here by virtue of the fact that the functions which it suggests are discretionary. The section, in so far as subsections (1) and (2) are concerned, would be made much stronger if the word "may" was changed to "shall" and if the discretionary powers were made mandatory.

At the outset I should like to indicate, at the risk of provoking the House, that I would not be averse to a mandatory provision in relation to section 35 because I feel so strongly about this question. On the other hand, irrespective of my personal views, if the nursing profession is to be self-regulatory, a self-disciplining body laying down the criteria of status for itself, the provision in section 35 should be enabling. We are enabling the board to have a central applications bureau established in three specific areas. The board may determine under section 35 the minimum educational requirements necessary for entry into training. Secondly, the board may establish a CAB to process applications. That is a discretionary enabling provision. Thirdly, the board, if it goes through those two processes — I have no doubt but that it is the wish of the present board to do so — a hospital or an institution approved by the board shall not without the consent of the board accept for training any person who is not approved of and recommended by the board. It is fairly rigorous at that stage but it is still very global. It has to be because it will enable the board, having set down the basic educational criteria, having established the CAB to send to a hospital where there may be 20 student vacancies a list of 60 or 100 qualified applicants, but they will be people who in the first instance will have minimum educational qualifications.

There will be no back door entry into nursing, no local preferences and no specialised representations from anybody on behalf of an individual. I hope the central applications bureau will operate with absolute objectivity, absolute equity as between one applicant and another and absolute fairness in terms of assessment, be it psychological or examination-wise or otherwise in terms of drawing up an approved list of candidates for a particular area. It may decide to regionalise the candidates coming before it. It may decide to individualise them in terms of particular hospitals and then forward prospective lists of student nurses. That is a discretionary and enabling aspect. There may be 20 vacancies and it may only forward 20 names. That will be the privilege of the CAB. On the one hand there may be 30 vacancies and it may forward 100 names.

In the framework of this legislation I do not think I should lay down an all-embracing structure because once An Bord Altranais have power to set up a central applications bureau they should go ahead and do it, assessing as best they can with the information available to them, the manpower data available and the future needs of nurse student training in the country assessed and available. The Department of Health, and the Minister of the day, should not do for An Bord Altranais what they are obliged to do on an enabling basis for themselves.

I am adamant about the need for this provision and it has met opposition. I have been left in no doubt about the opposition to the concept of central selection. I should point out to the administrators of some hospitals who were opposed to this, the board members of some hospitals and some members of the nursing profession who are opposed to it, that the working party on general nursing recommended it. It is not some Machiavellian dream of an obdurate controversial Minister for Health who has every misinterpretation heaped upon his head. It was a respected body of matrons, educationalists and medical profession representatives and departmental representatives — 25 people were at one time on that working body and they were all expert within the professional area — who unanimously recommended the central applications bureau in this framework. When is comes to putting this into operation some of the Opposition — to use a derogatory phrase which I should not use but it crawls out from the woodwork — say special privilege is being taken on by this selection process.

I would stress to the hospitals concerned that they are not being asked to hand over the selection process to some kind of bureaucratic statutory inanimate Bord Altranais. They would be asked at the worst to accept that their peers, medical consultants — there are only three of them out of 29 — a large number of senior tutors, administrators, hospital representatives at the highest level, a total of 17 elected members, should set up the system. A lot of them would be from nursing training schools and they would be as well qualified as some of the matrons who sit in a back room meeting streams of student applicants, some with letters from politicians, some with letters from their brother-in-law who is a parish priest or a good reference signed by a Senator or Deputy, or a Minister which would probably kill her prospects of being accepted. Of course, those letters are no longer written in the Department of Health.

Each school would retain a circumscribed right to determine the suitability for employment of the applicants and it would be quite different from the criticism levelled by Senator Fallon in relation to the university central applications bureau system. There has been criticism of the university CAO. It is a great deal better than it was in the fifties when I had the privilege of being accepted as a student. Being the son of a trade union official there was consternation in the academic body at the idea of such an inmate being permitted into the hallowed institution in Cork. We got over that and that is one of the reasons why I feel very strongly about this kind of development at statute level. Under the central applications bureau in our universities it is true that students finish up in courses leading to professions for which they may not be particularly suited but that is because of the generality of application for university training. The CAB proposed by us relates to nursing only and the arguments about the defects of the university CAO is not relevant.

It is contradictory to suggest that people enter walks of life not particularly suited to them. If we want to improve and develop the system we must bring in an effective system of selection for student nursing particularly these days when the nursing profession is a matter of enormous educational aspiration for many people, a matter of substantial professional standing within our community and a matter of major employment. There is very little unemployment in the profession. The nonsense that 2,700 people are unemployed is pure mythology. If one looks at the advertisements in the newspapers and rings the hospitals afterwards to see how many people applied for the jobs, one is told by hospital administrators that while many people want to become student nurses, and there is a limitation to the numbers of nurses we need in the country, the number of nurses particularly in the specialised area, available for employment is extremely limited.

The general level of social acceptance of student nursing or nursing generally is extremely high and for these reasons, and they are good reasons, and if only for those reasons, there should be a fair and equitable system of personal assessment to go into training, to remain in training and to emerge with a qualification. This goes down the road a long way and I hope it will come into operation. I have every confidence in the capacity of the current chief executive officer of An Bord Altranais, Mr. Daly, to bring in a system in consultation with the newly elected and the newly appointed members in 1986. It can be done. It should be done. It will mark a milestone of reform in our training of nurses. I have no doubt that it will be a practical demonstration of the merits of this Bill in future.

The amendment provides that the training schools shall select their own candidates for nurse training. There is no point in this if they are going to finish up doing all the selection as effectively the whole thing would be nullified and it would not be worth a candle in that regard. On that basis I strongly recommend that the amendment should not be accepted by the House. I am unable to accept both amendments as proposed at this stage.

Before calling on the next speaker, Senators, including the Minister, seem to be discussing the whole section and not the amendment. The Senators should keep to the amendment.

Before we finish with section 35, I cannot let the Minister away away with the remarks he made implying that only the daughters of "big shots" people the corridors of our hospitals and that if one were a trade unionist's daughter or son one would only now have all the doors open to one as a result of the passing of this legislation.

I lived next door to two hospitals for the first 20 years of my life and I know what it is like.

When the central bureau is set up anybody can become a nurse. The Minister's thinking there is wrong because some of the best nurses in top appointments in some of our hospitals are not the sons and daughters of "big shots". The Minister seems to think that now there will not be political influence and that there will not be TDs' or Senators' letters being sent in on behalf of candidates to secure an interview or to be shortlisted. I have made representations for students in the mid-western region, but I did not get anywhere. Maybe myself and the CEO are not on the best of terms. If I thought that this central applications bureau, without input or consultation with the training hospitals, would say who went into their corridors to qualify, I would go the whole way with the Minister. When the Minister gets something into his head, that is that. It is not so, and the Minister is wrong to think that the places in all the training hospitals, before this legislation, were held for a certain section of the community. It frightens me to find that the Minister knows so little about the personnel manning the hospitals.

I support Senator Fallon's amendment. If I have broken the rules, so has the Minister, and it is not the first time we have broken them and it will not be the last time either. The Minister seems to think that it is from now on that everybody will get a chance, and that up to this evening it was only a certain section of the people who were accepted into nurse training. That would want to be made clear here. Obviously I know more about the nursing personnel than the Minister.

I have considerable sympathy with the Minister and, indeed, with Senator Honan, because to discuss the amendment one must also discuss the position that will exist as a result of the amendment being passed as distinct from the position which exists now.

You can do that on that section.

What one is doing surely is contrasting the position that would happen in the event of Senator Fallon's amendment being passed as distinct from the position that will be brought about if it is not passed. If the amendment we are discussing is passed subsections (2) and (3) would be deleted and a proviso put in that training schools shall select their own candidates for nurse training. As the Minister rightly pointed out, that amendment having been made there would still be one very fundamental charge coming about, a fundamental change of which we must take note, that is the proposal that, with Senator Fallon's amendment, the position would be that minimum educational qualifications could be laid down. The Minister would be doing less than justice to Senator Fallon's point of view if he did not recognise that that is probably the greatest change that could be brought about as a result of all this process, that the laying down of minimum educational qualifications would in itself be a very desirable thing.

The second matter which Senator Fallon's amendment proposes is that three would be a central applications bureau and that, of corse, would also be a significant change, but Senator Fallon is then proposing that the power of that central applications bureau would be strictly limited to a processing, mechanical or clerical role and that the actual selection would remain at hospital level. Senator Fallon is going too far in his amendment but at the same time the Minister is over-reacting to what the Senator said. I have no ready solution to the problem but there is some merit in the point of view that if what we are talking about is a central applications bureau, if Senator Fallon's amendment, or some amendment, is not made it will not really be a central applications breau at all it will be a central selection process, and that is what we would call it. We should not call it an applications bureau and thereby equate it to the system in universities. The Minister will be aware that at university level each college establishes its own educational or entry requirements and the applications bureau merely works within that framework. What is proposed here is more fundamental. It is supposed to be a central selection process. Senator Fallon is going a bit too far when highlighting the problem by saying that there should be no say at central level other than in relation to minimum educational requirements. There is room for compromise here with regard to the way in which this process should work in the future.

I foresee problems and I understand the privilege to which the Minister refers and I agree that it is important to eliminate it. The Minister should also recognise that there could be a substantial problem with a selection process on a national basis which would of necessity have to select people strictly on the order of merit irrespective of where they lived. There could be a massive movement of students from one part of the country to another because the process would not have recognised where they lived. That is a criterion which needs to be taken into consideration also, for the purpose of establishing whether a person should be recruited for a certain teaching hospital.

It is not realistic to suggest that the 19 people on the board will take part in the selection process. They will establish the guidelines but they could not possibly take part in the process because of the number of applications and the number of places where decisions will be taken. The members of the board will not have an executive function in that regard and nated to somebody else.

The Minister's approach is acceptable without the amendment because the amendment is very much a straitjacket. It says only that local people decide. At least the Minister's suggestion gives the possibility that a flexible system would be implemented where a board, which would be representative of the central applications bureau and local people, might have a function to play. The way in which section 35 is drafted allowed for that possibility. In considering Senator Fallon's amendment the Minister should also consider whether some more clear criteria should not be laid down for the board to help in drawing up these schemes so that they could overcome the may be selected for the job purely on the basis of, for example, their leaving certificate results. That is not a very sensible way in which to select people for the nursing profession. I cannot support Senator Fallon's amendment because it is unnecessarily simplistic, but he has highlighted a problem and the desirable objectives which the Minister has set would be better met in the long run if he expanded further within the confines of this Bill the criteria which should be used in selecting people on a regional basis for individual training establishments.

The Minister has gone a little far in the way he has addressed this question. I support Senator Honan in that I do not believe that the nursing profession has been the domain of the elite and I speak for the mid-west region. Many nurses would look aghast at the Minister's view in this area.

No matter how one tries to assess candidates for a job and no matter how independent the board are, there are instances where independent decision produced disastrous results. There is not enough evidence to suggest that a central processing board are incapable of making mistakes or that they are better than any other method of selection. A few weeks ago I had an opportunity to sit on an interview panel. On that occasion one candidate who was adjudicated to be in second place had an excellent interview. About a month later that same candidate appeared before the same panel for another job and her interview was disastrous and I would have made an entirely different decision on the second day from the one I would have made on the first interview so I do not attribute blame for various decisions.

It is vitally important that the hospitals have some say in the appointments. I do not disagree with Senator Fallon, but I am not sure that I would be a clear and significant input by the different components in our hospitals system in regard to the kind of personnel they wish to recruit from time to time. If the Minister was managing an institution or a factory or providing a service he would not accept that he could have no say and practically no input into the type of individuals that he would have to manage from time to time. If it is left entirely to the central applications bureau to the central Donegal, for instance, will get a job in Cork and vice versa. What we are trying to do at this stage is to establish beyond all shadow of doubt that the process involves a significant input from the various training hospitals into the recruitment of their trainees. It is not fair of the Minister to accuse people putting that point forward of wanting to maintain privilege. It is less than honest of the Minister to try to impute that to individuals who are making their best efforts to improve this Bill and be as fair as possible to the numbers of people who will want to join the nursing profession. It does not do anything for this House to suggest that in this effort we are making, we want to ensure that only privileged classes will join the nursing profession. That has not been the case up to now. Many of us would fight that as strongly as the Minister or anybody else. Therefore, the Minister, even if he does not find it possible to go the whole way with this amendment, which I recognise present difficulties, should travel down some distance of that road or indicate to us fairly positively significant input into the recruitment of their training nurses.

Progress reported; Committee to sit again.
Sitting suspended at 5.30 p.m. and resumed at 6.30 p.m.
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