We have three amendments. Amendment No. 2 is an alternative to amendment No. 1 and amendment No. 3 is consequential on amendment No. 1. Amendments Nos. 1, 2 and 3 may, therefore, be discussed together.
Nurses Bill, 1984: Report and Final Stages.
Government amendment No. 1:
In page 12, to delete lines 41 to 50, and in page 13, to delete lines 1 to 8, and to substitute the following:
"20.—(1) Where a person who is either an officer or a servant of the Board is —
(a)nominated as a member of Seanad Éireann, or
(b)elected as a member of either House of the Oireachtas or of the Assembly of the European Communities, 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 such Assembly to fill a vacancy,
he shall thereupon 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 in respect of the period commencing on such nomination or election or when he is so regarded as having been elected, as the case may be, and ending when he ceases to be a member of either such House or such Assembly.".
The purpose of these amendments, and they relate to section 20 of the Bill, is to protect the employment of staff of An Bord Altranais who may be nominated for Seanad Éireann or who may be elected to either House of the Oireachtas or to the Assembly of the European Communities or regarded, pursuant to the European Assembly elections legislation, as having been elected to the Assembly until the commencement of such nomination or election. I should explain that the present position is that under section 21, which is the standard provision for statutory bodies, a person would stand seconded from employment by the board for the period of his or her nomination as a Member of the Seanad or appointment to the European Assembly or nomination as a candidate for election to either House or to the Assembly. Objections were raised in the Seanad, notably by Senator Patrick Durcan, to the provision regarding nomination as a candidate for election to the Seanad on the grounds that under the current Seanad electoral legislation a person can be so nominated without his or her consent and cannot then withdraw his or her candidacy. It was contended that valuable persons may be lost to statutory bodies because of nomination for election and they may not in fact succeed in being elected. I have agreed with Senators that this is an undesirable situation and I propose to amend section 21 accordingly. I feel, however, that following the precedent which I set on the Combat Poverty Agency Bill, any amendment should also provide protection for persons who are nominated for election to the Dáil and to the European Assembly. The amendment before the House now provides accordingly.
I would simply like to say that I welcome the Minister's amendment and in doing so I want to indicate at this stage that I will not be moving amendment No. 2 which is in my name and the name of Senator John Browne. I welcome the fact that the Minister appreciates the difficulty which the section as originally drafted and passed by the Dáil would create. I am glad the Minister has responded to the arguments which we raised at Second Stage and again on Committee Stage.
This amendment is one we would not oppose in any way. We would advocate it as being right and proper and it has our goodwill.
Amendment agreed to.
Amendment No. 2 not moved.
Government amendment No. 3:
In page 13, lines 16 and 17, to delete "mentioned in paragraph (a) or paragraph (b) of that subsection", and to substitute "therein mentioned".
Amendment agreed to.
Perhaps the Minister would like to make a few comments on the Bill before I speak. There are a few remarks that I want to make before this Bill passes.
Would Senator Honan wait until the Final Stage?
Bill received for final consideration.
Agreed to take Fifth Stage today.
Question proposed: "That the Bill do now pass."
I was hoping the Minister would make his remarks before I make mine but obviously he is not going to do so.
I should like to make two or three remarks.
And I will speak after you.
Is the debate open to any other Member who may wish to contribute or is the Leas-Chathaoirleach afforded special privileges?
The Leas-Chathaoirleach is afforded no privileges in this House.
I would make the broad point that since this Bill came before the House last July it has had a lengthy and thorough debate. I want to thank the Members of the House for their contributions. The Bill has been amended in several respects since it first came before the Dáil in May 1984. The amendment today on the election of Members or staff I shall have to bring back to the Dáil. There can be little doubt now but that cohesive and comprehensive legislation has been enacted. I want to thank not just Members of the House but also the nursing profession, the very many representative bodies and the many individuals who made representations to me and to Members of all sides of this House and also the Members of the Dáil in relation to the Bill. In the very early stages I did invite comments from interested parties on the Bill and I certainly received them in abundance, both written and verbal since the Bill was initiated.
My final comment before we hear the views of Senators is that it was gratifying to me and to my departmental colleagues to find such an extraoidinary level of interest in the Bill among nurses and among personnel connected with the health services generally. I admit that my exchanges with them have not been without some contention on occasions but that is part and parcel of putting new legislation on to the Statute Book. I would be concerned if a major Bill of this nature had been received with apathy in the areas it directly concerned. We now have a Bill which is a worthy addition to the Statute Book and is a very firm foundation for the regulation and development of nursing for many years to come. I thank Members and you, A Chathaoirleach, for your assistance in facilitating a constructive debate on the Bill.
Before I call Senator Fallon, I want to say the debate is wide open and Senators may talk for as long as they like but only once and only on what is in the Bill.
I shall not be very long. As the Minister has said, this debate has gone on since May 1984 and the Bill has been discussed not just by politicians but by nurses. The man in the street has taken a particular interest in this legislation. I would like to pay tribute also to the great nursing profession we have in this country. My hope would be that this Bill would be appropriate for the needs of the nursing profession for many years to come. An Bord Altranais have been very successful and tribute should be paid to them again. They have done a good day's work for the nursing profession. New medicines and new techniques are bringing dramatic changes. We come back to the question of perhaps one of the disappointments in the Bill in that we did not introduce the conscience clause. This clause operates in the North of Ireland in some form. Many nurses would have a great welcome for a clause of this nature because of the changing times ahead. Perhaps in the future it can be brought in somewhere else. In the last few weeks as a result of the problem in the Galway Regional Hospital more and more nurses have taken an interest in it. Since that episode nurses have written to me more than ever before on that section.
Overall, we are in for a period of change in the whole area of medicine. This Bill provides for the establishment of a board to be known as An Bord Altranais. This board will provide for the registration, control and education of nurses and other matters relating to the practice of nursing and the persons engaged in such practice.
My hope will be that when the election for places on this board takes place the nursing profession will give very serious consideration to the type of people they would like to have on the board. They will have in many ways total control of the board. One of the biggest changes that has taken place is that the Minister has increased the number of nurses by election from 15 to 17, which was a significant move. I know that the nursing profession, as a result of all the discussions and debates that have taken place right across the board, will give a lot of consideration to the type of people they would like to have on the board. That is very important. It should be highlighted that when the elections begin for this board only the very best of the nursing profession will win their places in those elections. My hope is that this legislation will be appropriate for the years ahead, whether it be 25 or 45 years, and that the new board whenever it is elected will have a very successful tenure of office.
We are living in a time of tremendous change and we, as legislators, have a duty to recognise that fact. In so far as we legislate for particular interest groups in our society we have a duty to ensure that the legislation we enact reflects that change and caters for those interest groups in a protective way in the years to come. I believe that in our debate and deliberations on this Bill and in the legislation we have ultimately produced here we have done that. We have on the one hand established a framework within which the nursing profession can develop constructively and openly over the next 20 or 30 years. On the other hand, we have recognised the individual nurse as somebody who has a particular relationship with a patient, a relationship that is different from that of a doctor and a relationship which reflects very much the positive characteristics and the caring capacities of that individual nurse. I would compliment the Minister for getting that balance right in this Bill. It is difficult to get that balance right. It is difficult in an age when the nursing profession will increasingly be under threat of attacks of various kinds. It is increasingly difficult to get that type of balance right and to ensure on the one hand that they are protected and on the other hand, the public they serve are protected and given the kind of service they deserve.
The new board, as the Minister has said, will be dominated by nurses. These nurses will be representative of the broad range of the nursing profession. That board is a suitable mechanism to guide the profession forward. The fitness-to-practice procedures which we have established within this Bill are adequate. They are also procedures which get the balance right as between the rights of the nurse and the rights of the members of the public.
I welcome the provisions of the Bill in relation to education and training of nurses and particularly the provisions in relation to registration. If this type of legislation is to be effective there must be an adequate registration system. The current system of registration of nurses is unsatisfactory in that there appears to be a large register there, not necessarily a live register. The enactment of this Bill will ensure that there will be a live and relevant register of nurses in operation. That will make the administration of the nursing profession much easier for administrations. I expressed my views on the right of conscience aspect.
That is not in the Bill.
It is in section 51.
The Minister suggested last week that section 51 dealt with the right of conscience. I will be guided by the Minister on matters of this nature since he is the person who is promoting the Bill. I share the concern expressed by many nurses that that section was not made a little stronger and that it did not move in a different direction. On the other hand, I listened to the arguments which the Minister put forward, discussed his point of view with various nurses and I think a broad sense of satisfaction has descended upon the nursing profession.
I will conclude by complimenting the nursing profession, the matrons and individual nurses, male or female, who approached me and many public representatives regarding this Bill. We frequently introduce legislation in this House which affects people and we get no response from those people. It is a great thing when people for whom we are legislating show such an interest in the legislation.
I would like to compliment the Minister. The Minister has become the great hate figure of certain sections of Irish society. He has become the butt of many comments of an unfair nature from Opposition speakers, not merely in this House but outside. There was a note struck throughout this debate, both inside and outside the House, that "this Minister", not "the Minister", was reserving to himself powers for a particular and peculiar reason. I do not believe that argument. Those who put forward that argument did so without any basis. The manner in which the Minister has approached this Bill, his openness in bringing it before both Houses of the Oireachtas, his willingness to listen to every argument and to accept amendments is a clear reflection of his democratic nature. I thank him; and I think that the nurses of Ireland, when they fully appreciate this Bill, will also thank him.
I want to say, Senator, that the question of conscience does not come within the Bill. Section 51 (2) reads:
It shall be a function of the Board to give guidance to the nursing profession generally on all matters relating to ethical conduct and behaviour.
I want to be sure that I have not been acting outside the terms of reference——
To me, yes.
That speech was only made before I got up. First of all, I would like to thank you for your kindness in allowing me to speak. Senator Durcan has just made a smashing Coalition speech. One would imagine that everything in the garden was rosy from the way in which he was complimenting the Minister.
Everything is very rosy.
I would like to say, before we complete this piece of legislation, that my regret is that the nurses of this nation did not lobby in time for a Bill that is going to affect them more than they had realised. I understand why the nurses had not time to go through it section by section because they have more than enough on their plates when you have only one nurse to 50 patients. They would leave it to us as legislators to make sure that the proper Bill went through, that it would not affect them in any way.
I must take the Minister to task for something he said in the Dáil on 5 December 1984 when he was speaking about the fees. He seemed to think that the nurses were objecting to paying a fee. That is untrue. The nurses were concerned with this section of the fees in case it got completely out of hand; they were only asking that it be kept under control. The Minister for Health said that it should be remembered that there are young nurses who would go on a Continental holiday spending £300 at the end of a year's work, that it would not cost them an awful lot of thought, and that they were screaming about paying a fee. That was an awful remark for any Minister for Health. He knows as well as I do that those nurses are entitled to whatever holidays they want.
The Central Applications Bureau is accepted in total by the nurses. There are hospitals that are asking for some system of selection for their candidates. This is where I ran foul of the Minister in his remark that it was only for people who had pull and influence. There would have been more amendments to this Bill if the nurses had the power and the lobby and the heavyweights behind them outside the House that the dentists had at the time the Dentists Bill was going through. The nurses are on a lower level and they had not got that kind of muscle. This is why I feel strongly about the sections that they feel strongly about. I would hope that An tUachtarán, Dr. Paddy Hillery, will take a look at the section that you, a Chathaoirleach, tell me I cannot talk about and that is the conscience clause.
That is much better not said now.
I have to clear one point. Senator McGuinness, whose views I always value and I hope I will always do so, on Committee Stage thought I was only interested in the rights of a nurse and that I would forget the rights of a patient. I was well aware that the right of the patient is equal to the right of the nurse.
I thank the Minister for his Bill. I will not make the type of plausible speech that Senator Durcan made because Minister Desmond would think I had gone cuckoo. That is not my style. I welcome the Bill if it corrects the wrongs that were there. I was one of the people in my party who saw long ago what the nurses would have wanted. I do not claim all the credit but this Bill might have gone through the other House much more quickly if I had not been aware of some of the sections and the effects they might have had. I support the tribute to the nurses. It may not be too long before we get back into power and there might be a few sections that we would repeal.
That certainly is not in the Bill.
I am not sure whether that is a promise or a threat. I am pleased that, at last, the Nurses Bill, 1984 has become the Nurses Bill, 1985, and hopefully the Dáil will pass the amendment we passed today in connection with nomination and membership of Seanad Éireann which is a very important amendment to have in any legislation. I would ask that future legislation should not wait for us to amend it in this regard. I thank the Minister, because this is about the third piece of legislation on which he has accepted amendments from us in this regard. He did likewise on the Dentists Bill. I am sorry if Senator Honan cast any aspersions on the Dentists Bill because in my opinion and indeed in the opinion of many people in society — consumers included — that is good legislation.
That is not in this Bill.
A comparison was drawn by Senator Honan between the lobbying by nurses and the lobbying by dentists. It is important for us as legislators not to insulate ourselves totally from the electorate whether they lobby us or not.
The Senator does not have to lecture me.
The nurses were not slow to make their views known on this. They might have been slow to make them known to Fianna Fáil because they knew that it was practically valueless.
It was you they had to work on, not us.
The nurses made representations directly to us, and not alone to us but to the Minister. There were proper consultations and meetings with all the people concerned before the Bill actually came before the House. The trade unions representing the nurses were fully briefed and consulted with, but it is our job finally to legislate. Having listened and talked to nurses about this legislation, I know they welcome it.
The Cathoirleach ruled on the question of the code of ethics and ethical conduct and behaviour. The Opposition made an unsuccessful endeavour to get an amendment passed, but the level of debate in that endeavour was so high and so good and the response from the Minister was so explicit that the nurses, who were originally concerned about this section, are no longer concerned because this Bill does not ask the nurses to do anything that would be unethical or immoral. It sets up a nursing board which in turn will have the right under the Bill to set down a code of ethics. I am very pleased that the majority of members on the board will be nurses. Up to 20 of the 29 members can be nurses. I have the greatest respect for the profession and am confident that their election process will ensure that the people who adequately reflect their views will be elected to the nursing board. I have the greatest confidence that they will set down, in the interests of their profession, a code of ethics and behaviour that will be becoming to the nursing profession, to which we have all paid tribute. None of us has been slow to compliment this profession because it is not just a job, it is a way of life, a vocation.
When we legislate for people of the standing of nurses it is important that the legislation would reflect to a great extent the views that they express to us. I am satisfied that the representation they will have on the board will adequately do that. To legislate beyond that would be putting requirements by legislation on the incoming board which would make them ineffective. For that reason the Minister's response to the debate at that level was welcome and certainly was understood by nurses who took the trouble to read it and discuss it in their groups. There are nursing groups meeting to discuss this and to discuss the Minister's response. There is no doubt whatever now in their minds that their fears in this regard were unfounded.
There is general approval for the Central Applications Bureau. I have made my views known on the importance of this, how important young aspiring applicants for nursing consider it and the inconvenience that will be removed. At the moment they have to apply to various training hospitals and health boards throughout the country at considerable expense. I am satisfied also from the Minister's response to this section that the private institutions and other hospitals will have a say finally in the type of nurse they employ and that is their right. It is accepted by the Minister that, even in spite of the Central Applications Bureau, the process of involvement of these people at that level will not be interfered with. It could be that for many reasons, commitments that the Minister has given publicly in this regard are ignored; but the important thing is that he has given them. It is on the record of this House and I am sure that the people involved will accept that for what it is worth. I am not making a political comment; it is the truth. The Minister has legislated in more areas in the Department of Health than many other Ministers for Health in all Governments. The report from the joint working party, which was the foundation of this Bill, was published ten years ago. How many Governments have we had in the past ten years? How many Ministers for Health have we had? But this Minister for Health has actually introduced into the Houses of the Oireachtas legislation which affects this very important profession. For that reason it has been widely recognised and accepted throughout the country for what it is — legislation that was necessary. I compliment the Minister and all those assisting him for the way in which they promoted the legislation, the way in which they have dealt with amendments and the level of the debate. It has served a useful purpose in this House in that we are seen as having an involvement in the process of legislation. In the case of other pieces of legislation with which we have been involved only the Dáil seemed to be significant. I am thankful that in this area, and indeed in regard to the Dentists Bill, the Seanad was seen for what it is — an important part of the legislative process of the Houses of the Oireachtas. I am proud to have been part of that procedure and I compliment the Minister for the way in which he dealt with it.
After 250 years this House is experiencing a period of recovery from rather difficult dry rot and after 25 years our legislation relating to nursing is recovering from a period of lack of reform. I am glad that, after three years of legislative endeavour on the part of the Government, on the part of the senior officers of my Department, on the part the parliamentary draftsman and, finally, on the part of both Houses of the Oireachtas, the legislation is now on the point of presentation to the President for his consideration and signature. I wish to thank the Cathaoirleach for his assistance in facilitating the very constructive debate on this Bill.
To conclude, I want to put a few final points to bed, and I hope they will stay in bed for another few decades. Firstly, regarding the conscience clause, there is no conscience clause in Northern Ireland, and we should be very clear about that. There is a piece of abortion legislation in Northern Ireland and within that specific legislation there is a conscientious objection provision. The clause operated by the nursing boards in Northern Ireland and Great Britain is identical to the one we have in the Republic. It is a very general one, namely, that any nurse should make known to the appropriate person or authority any conscientious objection which may be relevant to his or her professional practice. It is a very broad observation, but it is not a specific opt-out conscience clause. There is a lot of misunderstanding in that regard, not least in our own country.
Secondly, I want to assure Senator Honan that I shall stand over my observations regarding the capacity of the nursing profession to pay retention fees and registration fees. I have been upset that some nurses have objected to the introduction of an annual retention fee. The registration fee currently is about £50. The annual retention fee, as far as I can recall, is about £12 per annum. To pay £12 per year to keep one's name on a register in a situation where the nursing profession in this country is relatively well paid in the public sector, is not unreasonable. There is many a student nurse, as I said in the Dáil, who can afford, without any misgivings, an annual holiday of £300 or £400 a year. The least we might ask is the introduction of a new retention fee because the new Bord Altranais, the National Nursing Board, will be self-financing from the 26,000 nurses and it will receive very limited assistance by way of Exchequer funding. But it is essential that it should be self-financing in its training work, in its general registration work and in the operation of the Central Applications Bureau.
I come to the bureau itself. I am pleased that, after all those years in which there has been not just perceived inequity in terms of the right of entry into the profession and the opportunities to go into the profession but also a great deal of concern, that structure, on an enabling basis only at this stage, has been introduced. That is of considerable merit. Therefore, I would make a final plea to the nursing profession that they should participate in the elections. The opportunity will be there very shortly to elect the 17 members on to An Bord Altranais. I hope the elections are held as soon as possible. I hope there will be a very substantial turn-out in the election itself. We are currently working out the regulations relating to the election. For the first time proportional representation will operate in the elections for the various panels. I would certainly hope that there will be no delay in going ahead with the elections as quickly as possible. After 25 years we have now got, by and large, a reasonably good Bill. There has been a protracted period for representations and I think we have endeavoured to be as cooperative as possible in considering the representations.
Finally I want to thank Members again for their co-operation at all times in the passage of this Bill and to thank them for their contributions.
Question put and agreed to.