Seanad Éireann debate -
Tuesday, 15 Nov 2011

Vol. 211 No. 7

Nurses and Midwives Bill 2010: Second Stage

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

Minister for Health (Deputy James Reilly)

The purpose of the Nurses and Midwives Bill is to enhance the protection of the public in its dealings with nurses and midwives and to ensure the integrity of the practice of nursing and midwifery. The Bill provides for this in a number of ways. It is the stated object of the board that the regulatory structure for the professions of nursing and midwifery would be brought up to date and in line with those for other health care professions, and this has been done. Accountability and governance are at the heart of the structure of the regulatory body.

As I am sure many Members are aware, the legislation before the House has been examined in great detail. I am aware that a number of groups have raised issues about some provisions of the Bill and I and my colleagues, the Ministers of State, Deputies Shortall and Lynch, as well as officials in my Department have undertaken detailed examinations of the issues raised. I refer in particular to the issue of the midwifery provisions contained in the Bill and I will address these in more detail later.

Before I go into more detail on the key elements of the Bill I would like to set out the intention behind this legislation and provide Members with a brief outline of its key features.

Senator Rónán Mullen

On a point of order — tá an óráid ag teacht.

An Cathaoirleach

The Minister to proceed.

Deputy James Reilly

I reiterate the fact that the purpose of the Bill is to enhance the protection of the public in its dealings with nurses and midwives and to ensure the integrity of the practice of nursing and midwifery. This legislation will provide for a modern, efficient, transparent and accountable system for the regulation of the nursing and midwifery professions, which will satisfy the public and these professions that all nurses and midwives are appropriately qualified and competent to practice in a safe manner on an ongoing basis.

The principal features of the Bill are the enhanced protection of the public in its dealings with nurses and midwives, the repeal of the Nurses Act 1985 and for a new legislative framework in respect of nurses and midwives. The regulatory body, Bord Altranais agus Cnáimhseachais na hÉireann — the Nursing and Midwifery Board of Ireland, will have a stronger governance and accountability structure. It provides for a non-nursing-midwifery majority on the board and on the fitness to practise committees. It recognises midwifery as a separate and distinct profession and provides that midwives attending a woman in childbirth must have adequate clinical indemnity insurance. It provides for improved investigation mechanisms for complaints about nurses and midwives, including the creation of an assessment committee prior to fitness-to-practice investigations, and the appointment of investigators to facilitate such preliminary investigations. Fitness-to-practice inquiries will generally be held in public. The legislation provides for the registration of nurses and midwives, the establishment of a register of those training to be a nurse or midwife and the prohibition of unregistered nurses and midwives engaging in the practices of nursing and midwifery.

The Bill provides for the approval of programmes of education and further education necessary for the purpose of registration, the specification of standards of practice for registered nurses and midwives, and guidance on all matters related to professional conduct and ethics. It further provides for a new statutory framework for the maintenance of professional competence of registered nurses and midwives, including an obligation on employers to facilitate the maintenance of professional competence and midwives, in particular by providing learning opportunities in the workplace. It also provides for the dissolution of the National Council for the Professional Development of Nursing and Midwifery.

I will outline in more detail the various Parts of the Bill. Part 1 contains preliminary and general information and provides the Title of the legislation. It sets out the definitions of words and terms used throughout the Bill and that midwifery is recognised as a separate profession from nursing. It provides the Minister with the power to make regulations under the legislation. It provides for the repeal of the Nurses Act 1985 and that any expenses incurred by the Minister in the administration of the Act can be paid out of moneys provided by the Oireachtas to the extent approved by my colleague, the Minister for Finance.

Part 2 contains provisions related to the board. The board will continue but will be renamed Bord Altranais agus Cnáimheaschais na hÉireann, or, the Nursing and Midwifery Board of Ireland. This not only reiterates the recognition of midwifery as a separate profession but helps to herald the new era in nursing and midwifery regulation.

I will outline some of the more important sections in this Part of the Bill, commencing with sections 8, 9, 13 and 15. Section 8 sets out that the objective of the board is protection of the public in its dealings with nurses and midwives and the integrity of the practice of nursing and midwifery through the promotion of high standards of processional education, training and practice and professional conduct among nurses and midwives. I cannot stress enough that the protection of the public will be central to the regulation of nurses and midwives.

Section 9 outlines the functions of the board. These include the registration of nurses, midwives and candidates for these professions, the regulation of education and training and recognition of qualifications of nurses and midwives, including qualifications awarded in other countries. Other functions will be the setting of standards of practice and ethical guidance for nurses and midwives, the maintenance of their professional competence, the establishment of a code of professional conduct for registered nurses and midwives, the specification of criteria for the creation by employers of specialist posts, the handling of complaints and inquiries relating to the conduct of nurses and midwives and advising the public on all matters of general interest relating to the functions of the board and to nurses, midwives and their practice.

The board will also advise the Minister on all matters relating to the functions conferred on it by this legislation. It must have regard to the functions of other bodies and the policies and objectives of the Government to the extent that they relate to the board's functions. The Minister for Health will have the power to confer additional functions on the board.

Section 13 sets out the board's power to make rules for the purpose of the better operation of any provision of this legislation or at the request of the Minister. The board will make rules for the operation of committees; registration; receipt of evidence by the preliminary proceedings and fitness-to-practice committees; the establishment, membership, functions and procedures of sub-committees; the setting of standards and criteria for nursing and midwifery education and training; requirements for indemnity insurance for midwives and any professional competence scheme. To provide for greater accountability, draft rules will be subject to a period of public consultation and rules will be subject to the approval of the Minister for Health. In addition, the Minister for Finance must approve any rules relating to a professional competence scheme. Rules will be laid before each of the Houses of the Oireachtas.

Section 15 allows the board to enter into co-operation agreements with prescribed bodies to avoid duplication of activities and to allow for appropriate consultation and joint studies. It also provides for information to be shared. Section 16 allows the board to pass on information regarding the commission of an indictable offence, while section 17 prohibits the disclosure of confidential information unless it authorised by the board.

Part 3 sets out the board's obligations in regard to the preparation of a statement of strategy for its term of office and the preparation of annual business plans and annual reports. Part 4 sets out provisions for membership, committees and employees of the board. The key sections of this Part are sections 22 and 24.

Section 22 provides that the board shall have 23 members representing nursing and midwifery, educational bodies and stakeholders. Eleven members shall be nurses or midwives, of whom eight shall be elected. There will also be nurse representatives from general nursing, children's nursing, psychiatric nursing, intellectual disability nursing, public health nursing and nurses engaged in the care of older persons. In addition, there will be a midwife or nurse employed in the public health sector and engaged in the education of nurses or midwives. At least three of the elected members must be engaged in clinical practice. In addition, a director of nursing or midwifery and one nurse and one midwife from the third level education sector will be appointed as board members. The non-nursing or midwifery members of the board will be appointed from a variety of areas. The Medical Council, Health and Social Care Professionals Council and Health Information and Quality Authority will each nominate a member, the Health Service Executive will nominate two members and a member will be appointed from the voluntary sector. The Minister for Education and Skills will also nominate a member from a third level establishment. A further five members of the board who are not nurses or midwives and who have such qualifications, expertise, interests or experience that, in the opinion of the Minister, would enable them to make a contribution to the performance of the board's functions will be appointed.

The president and vice president will be elected by the board from among its members. The president of the first board does not have to be a nurse or midwife. However, subsequent board presidents will have to be nurses or midwives. The vice-president will always be a nurse or midwife.

The board's power to establish committees to fulfil any of its functions is set out in section 24. These committees will be established under board rules. Five committees will be established on a statutory basis. The preliminary proceedings and the fitness to practise committees will be established, respectively, to investigate complaints and to inquire into complaints made under the board's disciplinary procedures under Parts 7, 8 and 9. At least one third of the members of each of these committees will be board members and the majority of members will not be nurses or midwives.

The midwives committee will advise the board on matters relating to midwifery practice. Following further consideration during this Bill's passage through the Dáil, the minimum membership of this committee has been increased. The midwives committee will comprise at least eight members, including two registered midwife practitioners, two other midwives, of whom one may be a self-employed community midwife, a medical practitioner in obstetrics or gynaecology, a registered nurse board member and two persons who are representative of the public interest and who are not nurses or midwives.

I have received a number of representations in regard to the functions of this committee. In particular, an amendment has been sought to provide that decisions made by the midwives committee would be binding on the board. However, it is not possible for a committee of a board to make binding decisions on the board. This would be contrary to good governance because the board is accountable and responsible for decisions.

Two other committees will be established on a statutory basis. The education and training committee will perform functions in relation to the education and training of nurses and midwives and the health committee will support nurses and midwives with relevant medical disabilities or who have given consent to medical treatment under fitness to practise procedures. The Part also includes provisions for the appointment and terms and conditions of the chief executive officer, CEO, and employees of the board.

Part 5 contains provisions relating to the accounts and finances of the board, including provision that the board's accounts will be subject to audit by the Comptroller and Auditor General.

Part 6 sets out the requirements for the registration of nurses and midwives. Unregistered nurses and midwives will not be allowed to practise, except where rendering first aid. The board can issue a permit to a nurse or midwife who is registered in another country in circumstances where they are entering Ireland for a short period for humanitarian purposes for a period of no more than 30 days. The Bill sets out the penalties and offences for contravening these provisions. I intend to speak in more detail about the midwifery provisions of this legislation later, including the necessity for midwives who attend a woman in childbirth to have adequate clinical indemnity insurance.

I refer Members to sections 40(1), 46 and 50. Section 40(1) of the Bill provides that no person shall, for reward, attend a woman in childbirth unless the person is a registered midwife who maintains adequate clinical indemnity insurance in accordance with the rules. The provision continues on to list others who can attend a woman in childbirth. This includes a registered medical practitioner, a person undergoing training to be a registered medical practitioner or a registered midwife who gives such attention as part of a course of professional training or a person undergoing training in obstetrics who gives such attention as part of a course of professional training.

This provision is included as there is a need to ensure that midwives have adequate insurance lest a case of negligence is taken, as court cases relating to a birth where negligence is proven often result in very high damages being awarded. It would add further to the distress of the parents if a case of negligence was proven and the midwife involved was not insured. However, I will address this matter further later.

Another important section is section 46 which provides for the establishment of two registers. The nurses and midwives register will include the names and qualifications of registered nurses and midwives and will consist of at least two divisions — the nurses division and the midwives division. The board can create other divisions in the register. The candidate register will include the names and details of all those pursuing education and training leading to first time registration with the board. It, too, will contain a nurses division and a midwives division. The Bill provides that the registration of a nurse or midwife can be annotated to include additional qualifications. Both registers will be published. However, I assure Members of the House that personal information will be protected from disclosure. Conditions can be attached to a nurse's or midwife's registration as a result of a fitness to practise inquiry or a declared medical disability.

Section 50 sets out that a nurse or midwife can apply to have his or her name removed from the register unless they are the subject of a complaint under the board's fitness to practise procedures. The board may remove a nurse or midwife from the register if they are suffering from an illness or terminal illness which would render their practice unsafe and where they are unable to self-remove from the register. This Part also includes the board's and the nurse's or midwife's responsibilities relating to the maintenance of registers.

Parts 7, 8 and 9 set out the provisions with regard to the board's fitness to practise functions. Part 7 provides for the function of the preliminary proceedings committee, which will given initial consideration to complaints. It is section 55 in this Part of the Bill which provides that complaints can be made relating to professional misconduct, poor professional performance, non-compliance with a code of professional conduct, relevant medical disabilities, failure to comply with a relevant condition, failure to comply with an undertaking or to take any action specified in a consent given in response to a request under section 65 — where a registered nurse or midwife consents to a censure or remedial action, an irregularity relating to the custody, prescription or supply of a controlled drug or a conviction for an indictable offence in the State or in another jurisdiction. Part 7 also contains provisions for the appointment by the board of investigators to assist the preliminary proceedings committee, the ability of the board to make an ex parte application to the High Court for an order to suspend the registration of a nurse or midwife should this be deemed necessary for the protection of the public, the referral of complaints to another body, should this be more appropriate to the functions of another body, or to mediate. Section 60 sets out that the board may prepare guidelines for the resolution of complaints by mediation or other informal means. Both the complainant and the nurse or midwife must agree to participate in mediation. Complaints cannot be resolved through the giving or receiving of financial compensation. I am sure Members will agree there may be cases in which the use of mediation would be the most appropriate method of complaint resolution. This legislation will provide for its use but only as and when it is appropriate to so do. Each complaint to the preliminary proceedings committee will be examined case by case.

Part 8 sets out the role and duties of the fitness to practise committee and how hearings should be conducted. Provisions are included to ensure all parties involved in a complaint are kept informed regarding that complaint. For the purposes of an inquiry, the fitness to practise committee will have the rights and privileges vested in the High Court. In general, hearings of this committee will be held in public in a measure to improve openness and transparency. However, if an application is made by the nurse or midwife or witness, part or all of the inquiry may be held in private. I should mention section 65, which provides that the fitness to practise committee, with the consent of the board, may at any time during an inquiry request the nurse or midwife to give consent in respect of a board censure, undergo medical treatment or give an undertaking to take a course of action the committee deems the appropriate with regard to the resolution of the complaint. Where a required undertaking or consent is given, then the inquiry is considered complete. If a nurse or midwife refuses to give such an undertaking or complaint, the committee can proceed with the inquiry.

Part 9 sets out the duties of the board and the chief executive officer were complaints have been referred to the fitness to practise committee to inquire into. While the role of this committee will be to inquire into complaints, it is the board, as the regulatory body for nurses and midwives, that will decide on the appropriate measure to be imposed against a nurse or midwife. A key section within this Part is section 69, which sets out these measures, namely, an advice or admonishment or a censure in writing, a censure in writing and a fine not exceeding €2,000, the attachment of conditions to registration, the transfer of a nurse or midwife's registration to another division of the register, suspension of registration, cancellation of registration and prohibition from applying for restoration for a specified period. The imposition of sanctions is subject to High Court approval, except a decision regarding an advice, admonishment or censure in writing, and is subject to the right to appeal. The board is obliged to inform the Minister and the employer regarding the imposition of sanctions and to notify a registration body in another jurisdiction where it is appropriate to so do. Further to this, if the board deems it necessary in the public interest, the public can be informed of sanctions against a nurse or midwife and the board can publish all or some of an inquiry transcript.

Part 10 sets out the duties of the Health Service Executive, HSE, and the board with regard to education and training. The HSE will, in so far as is possible, facilitate the education and training of candidates for registration and will promote and co-ordinate the development of specialist education and training. It will co-operate with the board and training bodies in respect of workforce planning. The board will set and publish standards of education and training and will have the power to approve programmes and bodies for the delivery of these and to recognise qualifications awarded in other jurisdictions and will be responsible for the provision of career information on nursing and midwifery.

Part 11 contains provisions for the maintenance of professional competence by all midwives. It states explicitly that it is the duty of each nurse and midwife to maintain their professional competence, in particular through the provision of workplace learning opportunities. The board will establish a professional competence scheme or schemes to monitor the competence of all registered nurses and midwives in the State.

The demonstration of professional competence by nurses and midwives is a method of enhancing protection of the public. Many nurses and midwives already actively pursue the maintenance, if not the further development, of their own individual practise and many employers facilitate this. However, by placing the maintenance of professional competence on a statutory basis, all nurses and midwives will be obliged to maintain their competence. Where a nurse or midwife fails to demonstrate their competence at the request of the board, they will be subject to a number of actions which can include a requirement for training to ensure their practise is brought up to an adequate standard, or in more severe cases, the referral of the nurse or midwife to the board's fitness to practise procedures.

The National Council for the Professional Development of Nursing and Midwifery is dissolved under Part 12 of this legislation. The council was established in 1999 to further develop nursing and midwifery and has done excellent work. However, I consider that some of the work of the council is more appropriate to the board as the regulatory body for the professions of nursing and midwifery. Those functions that are not appropriate to the role of the regulatory body will be undertaken by the Health Service Executive under the provisions of the Health Act 2004. Furthermore, the dissolution of the council is in line with the rationalisation of State agencies.

I ask that my thanks to the National Council for the Professional Development of Nursing and Midwifery, its employees, its CEO, Dr. Yvonne O'Shea and its chair, Dr. Laraine Joyce, are read into the record of this House. This Part also provides for the transfer of the council's employees, assets and liabilities from the council to the board.

Part 13 sets out a number of miscellaneous provisions, including the provision that the board may investigate unregistered persons suspected of practising nursing or midwifery or claiming to be registered in contravention of this legislation and that summary offences under this legislation may be prosecuted by the board. The Schedule outlines the matters relating to the board and its members including its tenure, the split term of office for board members, resignations or determinations of membership, quorums for meetings, structure of meetings and the role of the president and vice president of the board.

I have just given an outline of the structure and contents of the Bill. I will now say a few words in regard to specific issues that have come to the forefront in the development of the Bill. Midwifery is now a separate and distinct profession, with its own direct entry career path via the undergraduate midwifery education programme, which commenced in 2006. The Title of this legislation, the Nurses and Midwives Bill, supports this distinction. The Bill also recognises that midwifery is a separate professional area to nursing.

I refer in particular to the provision that all midwives attending a woman in childbirth must have adequate clinical indemnity insurance. I am aware that concerns have been raised about the intention of this provision. I consider this provision necessary for the protection of the public. I consider it essential that all midwives possess adequate clinical indemnity when attending a woman in childbirth and that it is necessary that the penalties for any contravention of this are robust enough to deter any contravention. Midwives must have adequate insurance to ensure, in the tragic event of a catastrophic incident during a birth, where negligence is proven against a midwife and a court action results in damages being awarded, that these can be paid. It would add further to the distress of parents if the midwife involved was not insured. Damages in these cases are often very high.

It is only in regard to attending a woman in childbirth, that is, a woman's labour and delivery of the baby, that a midwife needs indemnity. A midwife is not required to have indemnity for other areas of her or his work. A midwife does not require indemnity, for example, to run prenatal classes or breast-feeding classes or any other services which do not involve attending at the delivery of a baby. In many cases, as midwives are employees of hospitals or other maternity providers that practise, their practices will be covered under the employer's liability cover.

However, there are a number of self-employed community midwives in the State. To facilitate them obtaining indemnity, an arrangement has been put in place to allow them to access the State's clinical indemnity scheme via the HSE. A self-employed community midwife who signs a memorandum of understanding, MOU, with the HSE and abides by its terms is covered by the scheme. The MOU is constructed on the basis of appropriate forms of governance, clinical supervision, clinical care pathways, performance management and audit frameworks being in place. The MOU outlines conditions and factors which indicate increased risk. There is a need to ensure that where the State provides clinical indemnity, a midwife adheres to the standards set out by the HSE. A national steering committee on home births has been established by the HSE and it is reviewing the implications of the MOU for the provision of a safe, evidence-based home births service for low risk women.

The committee is also drafting policy guidelines for cases that do not meet the inclusion criteria set out in the MOU. The committee comprises representatives of a wide range of stakeholders, including self-employed community midwives. The inclusive nature of the committee facilitates discussions on key areas of concern and will inform future guidelines and developments. A review of the MOU is progressing. I stress that access to the clinical indemnity scheme via the signing of the MOU is designed to facilitate self-employed community midwives to obtain indemnity for their continued practise as self-employed individuals. There is nothing in the legislation to prevent such a midwife from obtaining indemnity cover from a private insurance provider, should he or she wish. However, some midwives seek unlimited indemnity from the State. The State cannot indemnify midwives for high risk cases and it cannot be expected to provide unlimited indemnity without a governance structure. All insurance policies are replete with terms and conditions.

The Bill provides that midwives must have adequate indemnity cover in regard to their attendance of a woman in childbirth. This is a recognition that, while childbirth is a normal life event, it can have serious consequences if something goes wrong. It is not possible to legislate against catastrophic occurrences. However, the public can be protected, in so far as it is possible, through continuing professional development, lifelong learning and the maintenance of professional competence. After all, the primary intention of this Bill and the primary objective of the board is the protection of the public.

I support choice for women but the option of home births must be provided in a safe manner. Home births can be a safe option for low risk, healthy women. Low risk means no history of medical or surgical problems that might affect pregnancy and no present or previous pregnancy complications.

A second issue raised by Opposition colleagues in the passage of the legislation was the belief that decisions of the midwives committee would have a binding effect on the board but this is not possible. The board is the regulatory body for nurses and midwives. The decisions of a committee cannot be binding on a board. The committee structure of the board is designed to provide that people who are not board members can be members of a committee. This is to ensure board committees have a membership with adequate knowledge to fulfil the functions delegated to it by the board. However, the board has responsibility for the regulation of nursing and midwifery. I have ensured there is an obligation on the board to consider the advice of the midwives committee.

The legislation places the protection of the public at its core. This is reflected throughout its provisions and in the new governance structures for the board which focus on openness, transparency and accountability. It modernises the regulatory structure and places it firmly within the domain of protection of the public.

I thank the House and commend the Bill to it.

Senator Terry Leyden

I welcome the Minister for Health to the House. The Bill was introduced by the former Minister, Mary Harney, on behalf of the Fianna Fáil-Green-PD-Independent Government. The Minister stated in the Dáil on 6 May 2010 that there had been public submissions from more than 200 individuals and organisations. On 13 May 2010, on Second Stage, as then Opposition spokesman on health, Deputy Reilly raised certain issues and concerns he had at the time. It is interesting he is now in charge and the Bill is going through. I wonder if he allayed the fears he had at that point on the Bill?

Deputy Reilly said the board, at 23 members, was small. Time changes and with the advice from officials, the Minister has decided 23 is enough. He said at that time:

The board, at 23, must be compared with a 25 member board for the Medical Council. These numbers beg questions. I accept that the Minister cannot have a board of 50 as it would be far too unwieldy. Nonetheless, the Minister has a 25 member board looking after 7,000 medical practitioners and she will have a 23 member board looking after perhaps 35,000 nurses — certainly more than 25,000 practising general nurses. These numbers beg questions.

The Minister seems to have accepted that Mary Harney and her officials were right in their assessment.

The Minister also said when in opposition:

Every action the board takes must be directed by the Minister, with the agreement of the Minister. The independence of the board will be severely undermined in this case considering the number of individual board members appointed by the Minister. The Minister now wants the right to nominate the president of the board. This does not happen on any other registration board of which I am aware, such as the medical and dental councils who elect their own presidents. This is an extraordinary development.

Somehow, the Minister may have dealt with this in the Bill; the president will now be nominated by the board members for which I commend him. Last year the Minister said:

The Minister will need to explain the thinking behind this proposal. It leaves the Minister wide open to the accusation of political interference, not something the Minister would wish to be accused of. Fine Gael will oppose this provision.

Reading through the Bill he has dealt with those issues, for which I commend him also. As Opposition spokesman he saw these issues and made changes.

On home births, the midwifery aspect of the Bill is very important. When I was chairman of the Western Health Board, this issue arose many times. The Minister, as a doctor, would have views on this and would know that it is a serious question. Every birth is serious and can give rise to difficulties, even in the best possible circumstances. Safety is the main factor for midwifery and home births. As a father and a man, I acknowledge it is a woman's choice. The Minister said that in his summary and I respect his point, although he did say that everything must be equal and the health of the expectant mother must be practically perfect so no difficulties arise. If a problem arises in a rural area that is not near a maternity hospital, there can be catastrophic consequences.

The Minister already made that point.

Advice has been forthcoming from different quarters. I am the youngest in a family of eight and I was born in Roscommon County Hospital. My mother often informed me about the problems she experienced when giving birth at home. Things were very difficult at that time and I do not know whether my mother ever really advocated home birth. Women who gave birth at home during the period to which I refer were very courageous because they only had the support of midwives on which to rely. Some of the latter lived in rural areas and there only qualification came through experience. As the Minister stated, if a difficulty arose during childbirth at that time it could have catastrophic consequences.

I read the Minister's script in great detail and I am aware that he is being very fair and balanced. As he indicated, a national steering committee on home births has been established by the Health Service Executive. There are those who state that being able to give birth at home is a human right. That is fine but these individuals must be protected. The Bill stipulates that anyone involved in a home birth must have proper insurance cover in order that he or she cannot be sued at a later date if something goes wrong. Giving birth is difficult. I was chairman of my local health board when the Department purchased Portiuncula Hospital in Ballinasloe. That was a major decision on the part of the Department at the time, particularly as it was aware that it would be assuming responsibility from the difficulties which had arisen on foot of certain historical cases. Such cases arise all the time. There is more litigation now than ever before because if anything goes wrong, the hospital, doctors and midwives can be held liable and responsible.

This Bill is both good and comprehensive and I commend the Minister for bringing it forward as quickly as he has done. Most Senators in this House have gained election over the years by seeking the votes of other public representatives. I would be pleased, therefore, if the Minister would consider changing section 22(5) which states:

(5) A person is not eligible for appointment as a member of the Board, or of a committee, if the person is—

(a) a member of either House of the Oireachtas or of the European Parliament,

(b) regarded, pursuant to section 19 of the European Parliament Elections Act 1997, as having been elected to the European Parliament to fill a vacancy, or

(c) a member of a local authority.

Why would a member of a local authority who is a properly qualified midwife or nurse be deemed ineligible to be appointed by the Minister to the board? There might not be anyone else available to serve on the board at a particular point in time. A former Member of the Seanad, Ms Phil Prendergast, MEP, who made a great contribution to the work of the House from her election in 2007 until she replaced the current Minister of State at the Department of Transport, Tourism and Sport, Deputy Alan Kelly, worked previously as both a nurse and a midwife. I wish to illustrate for the Minister an example for the former Senator's generosity of spirit. I refer to the time when another colleague in the House was expecting a baby and when Ms Prendergast entered a pairing arrangement with her in order that she might have every possible opportunity to spend as much time as possible at home prior to and after giving birth. That was a very generous thing for Ms Prendergast to do and her actions arose out of her concerns as a qualified midwife.

The Minister has a long record of public service and I believe he served as a councillor before being elected to the Lower House. I am of the view that it is a slight on the members of local authorities that the provision to which I refer is included in every item of legislation. This practice has obtained for some time. It was employed by the previous Administration and the current Government has adopted it. We had great difficulty in persuading previous Ministers to remove provisions of this nature from legislation. It must be remembered, however, that in the context of what became the Personal Injuries Assessment Board Act, a former Senator was allowed to become vice chairman of the board of the PIAB.

Would it be possible for the Minister and the HSE to consider the possibility of providing outreach facilities to Roscommon County Hospital from Portiuncula Hospital and University College Hospital Galway, UCHG. The latter are hospitals of the highest quality and I commend the staff who work at each for the fabulous work they do. All of my four children and my grandchild were born at these hospitals. The staff there — consultants, midwives, etc. — are public servants, are extremely well qualified and provide tremendous support to expectant mothers. I request that instead of obliging expectant mothers and their spouses or partners travelling long distances to attend prenatal appointments, outreach facilities should be provided in a quality environment as near as possible to their homes. I am sure this could be arranged and I ask the Minister to give consideration to my proposal.

There was a maternity unit at Roscommon County Hospital in the past and when I became a Deputy in 1977, this was the most important local issue of the day. We tried to have an obstetrician-gynaecologist appointed to the hospital and the Minister will be able to peruse the file relating to the matter in his Department. The then Minister, the late Charles J. Haughey, made every effort to facilitate us. When I supported Charles J. Haughey in 1979 — this is a true story — I made just one request of him, namely, that Roscommon County Hospital would be retained, that services would continue to be provide there, that an obstetrician-gynaecologist be appointed and that the maternity unit be restored. He went as far as he could and even directed the officials of the Department to vote a certain way at meetings of the board. However, that is history and the facts relating to it are all a matter of record.

I thank the Minister, who has an extremely busy schedule, for coming before the House and for remaining here for as long as possible. It is always great when a Minister, particularly one of Deputy James Reilly's experience, comes to the House and listens to the views of Senators. I commend the Bill, which has my full support, to the House.

Senator Colm Burke

I welcome the Minister and thank him for dealing with this matter in a comprehensive manner. This is a wide-ranging item of legislation. I read the debates which took place when the previous Minister was involved with the Bill and it was interesting to note the contributions made at the time. A number of people made detailed submissions in respect of what should be included in the Bill. It is good to see the Bill continuing its passage through the Houses and I look forward to its enactment into law.

The purpose of the Bill is to modernise the legislation relating to nursing and midwifery in Ireland. It has been warmly welcomed by the National Council for the Professional Development of Nursing and Midwifery. Members of the health profession are anxious that it should be implemented at an early date in order to facilitate the modernisation of the law in this area. Nursing graduates in this country have excellent qualifications — degrees and diplomas — and their duties in the health service should reflect this. The enactment of the Bill into law will ensure that the nursing board, An Bord Altranais, will be in a position to register Irish, European and third country nurses in order that the health service might meet the demands and challenges it faces.

As the Minister indicated, the Bill recognises midwifery as a separate profession. The services provided by nurses and midwives form the backbone of the health system. The Bill will enhance and protect the reputation of Irish nurses. Existing legislation is outdated and the Bill will, therefore, be gladly welcomed. It is encouraging that there was a broad consultation process, involving the relevant stakeholders and representative bodies, in respect of the Bill.

I obtained some interesting statistics from An Bord Altranais which indicate that there are over 90,000 registered nurses in this country. Of these, in the region of 67,000 are active while the other 23,000 are inactive. The statistics to which I refer also indicate that these individuals possess over 122,000 qualifications between them. Therefore, the legislation relates to a large group of people who possess a broad range of qualifications. Those whom it covers are nurse practitioners, those involved in general practice, those who care for people with intellectual disabilities, midwives and psychiatric nurses. The Bill deals in a very comprehensive manner with each of the disciplines to which I refer.

The figures supplied to me by An Bord Altranais relate to 2010. They indicate that in Ireland, there were 1,873 newly registered qualifications in 2010. Some 292 of these were from EU countries and 46 from other countries. It is good to see that number getting the qualification and available to come into the health service. It is important to ensure that there are opportunities available for them to be part of the workforce in Ireland.

The interesting change in health care relates to the numbers being dealt with by the hospitals over the past ten years. In maternity care, the number of births has increased from 54,000 to 76,000 per annum. In that period, between 2000 and 2009, which are the years for which I have figures, despite the substantial increase in the numbers delivered, the perinatal mortality rate has decreased from 8.9 per 1,000 to 6.9 per 1,000. This achievement is a true reflection of the commitment of nurses, medical staff and all of those involved in the health care area. When compared to other European countries, Ireland has a far lower rate than some of our European partners. In three countries in Europe, France, Bulgaria and Malta, the perinatal mortality rate is greater than ten per 1,000 and Ireland's rate is 6.9 per 1,000. It is a credit to the health care service and to the nurses involved in that area.

The Nurses and Midwives Bill was restored in March 2011 and Report Stage in Dáil Éireann was taken on 20 April. This Bill represents practical reform and transparency for the appointments to the Nursing and Midwifery Board of Ireland. The current fitness to practice committee is governed by the Nurses Act 1985 and with the introduction of the Bill, a preliminary proceedings committee will be established under Part 7 of the Act which will update the law on complaints against nurses. The Minister outlined this clearly. This is a welcome change in the procedure for dealing with complaints.

The Bill is important also because of how we now deal with our international partners. An Bord Altranais has joined seven international nursing and midwifery regulatory organisations in signing a memorandum of understanding. The memorandum of understanding outlines the signatories' common agenda of co-operation to confirm closer links between the organisations to develop standards for the regulation of nurses, midwives and nursing practise and to facilitate the free exchange of professional knowledge that can contribute to the development of standards. This agreement was signed in May 2011. Basically, it is about arranging and having consultation between these seven international organisations including setting up project partnerships and joint committee memberships. This is a welcome development but it also outlines why we need this amending legislation on keeping up to date with our colleagues throughout Europe.

The Bill is designed to update provisions relating to the regulation of nurses and midwives by the regulatory body and to enhance protection of the public in its dealing with these professions. The Minister outlined the principal elements of the Bill. The provisions include: the repeal of the Nurses Act 1985 to bring the legislation up to date; provision for a regulatory body to be known as the Nursing and Midwifery Board of Ireland; a non-nursing midwifery majority on the board and the fitness to practise committee; and a prohibition on unregistered nurses and midwives engaging in the practice of nursing or midwifery, which is a welcome development. The Bill also provides that fitness to practise inquiries will generally be held in public. This is about the transparency which the Minister outlined. The Bill also brings into place the dissolution of the National Council for the Professional Development of Nursing and Midwifery. The Minister covered all of these matters in his presentation.

I refer briefly to one or two items. The board's functions will include: the setting of standards of practice and ethical guidance for nurses and midwives and the maintenance of their professional competence. The maintenance of professional competence is extremely welcome. It is also about ensuring that the bodies such as the HSE will make available the opportunity for nurses to continue to update their training and skills.

Section 8 provides for the protection of the public in its dealings with nurses and midwives and the integrity of the practice of nursing in general.

Section 39 provides that unregistered nurses and midwives may not practise nursing or midwifery or advertise that they practise that profession. In line with this provision, section 40 prohibits a person from attending a woman in childbirth for payment, unless the person is a midwife with adequate indemnity insurance. The Minister has dealt with this issue of insurance.

Coming from the legal profession, I am aware that this is one of the health care areas where there have been significant claims in maternity hospitals generally. It is an area of which we need to be careful, ensuring that there is adequate insurance cover for those working in that area. The Minister is correct in insisting on insurance. One of the submissions I received suggested that there is not a requirement for doctors to hold insurance, but that submission is incorrect. In fact, all doctors are adequately insured. Otherwise, they would not be entitled to work among the general public.

Section 45 states that a nurse or midwife who is not registered cannot charge or recover fees for nursing while he or she is not registered. It is important that there are such provisions in the Bill.

The Bill is comprehensive. There are more than 109 sections in it. It is well thought-out. I thank the Minister for dealing with it. It is important that it is put in place as soon as possible.

Senator John Gilroy

I welcome the Minister to the Chamber. As the Minister stated in his opening statement, the Bill has been a long time coming. It is to be welcomed as a mechanism to reform the regulatory framework surrounding the best practice and placing accountability and public safety to the forefront for all practitioners. I will have much more to say about the Bill on Committee Stage and will reserve most of my comments until then. However, there are one or two points I want to make. For simplicity sake, it is as well to speak about the Bill as it relates, in the first instance, to nurses and, in the second, to midwives.

The important point is that in repealing the Nurses Act 1985 we ensure that the powers conferred on the regulatory board are transferred in their entirety to the new proposed board as well as ensuring the enhancement of the authority of the new board. Nurses and midwives are the backbone of the health services and the importance of both as professions in their own right needs to be acknowledged, and the regulation of these services is particularly important.

I welcome the idea that we are taking a more strategic approach to regulation, particularly on the requirement of the proposed board to prepare a business plan for planned activities and an annual report to review activities. That is an important step.

The composition of the board, as laid out in the Bill, causes a little confusion. This might well be due to the wording and the way it is phrased. There is a requirement that eight registered nurses shall be elected to sit on the board. However, the paragraphs describing those nurses and from what part of the register they come leaves room for semantic confusion. For example, the Bill refers to clinical nursing in this regard. There is a grade of nurse called a clinical nurse manager. There seems to be some room for confusion on the semantics.

In addition to the registered nurses, section 22(1)(d) requires one person nominated by the Medical Council. This seems to be a legacy issue, perhaps a hangover from the past where it was considered that nurses are somehow accountable to the medical profession for their work practices. While it is acknowledged that all professions work closely in the clinical setting, the sometimes perceived hierarchy where the nursing profession is seen as ancillary to the medical profession needs to be addressed. While I have no real concern about this element of the Bill I am not sure the inclusion of medical personnel on the regulatory board of the nursing and midwife professions sends out the required message of professional autonomy. I ask the Minister to examine this.

Section 27 debars bankrupt people or those who make compensation arrangements with creditors from sitting on the board and I see little enough reason for such a provision. It appears to be out of tune with modern thinking on the matter and perhaps out of tune with emerging thought in other policy areas.

Midwives are greatly concerned that the Bill, particularly section 40 which the Minister mentioned, requires them to maintain adequate legal indemnity. Naturally, and obviously, nobody objects to being indemnified, but the manner in which it is provided for in the Bill may have a significant unintended consequence. A self-employed midwife must sign up to a memorandum of understanding with the HSE to obtain affordable indemnity insurance. The real issue which arises is that if a local hospital provides a home birth service, the self-employed midwife who operates locally will have no difficulty in obtaining indemnity cover. However, if there is no locally-based home birth service in operation in a particular HSE area , the major question remains as to whether a self-employed midwife can operate at all. This needs to be addressed and I have little confidence in the HSE to answer the question. The problem is probably related to how the rules will be formulated. A legislative text is required to oblige the HSE to do this. The implications of not doing it include leaving the provision of home births subject to the decision of a local HSE manager and not as a right of an expectant mother.

Senator Sean D. Barrett

I wish to share time with Senator Feargal Quinn.

Acting Chairman (Senator Imelda Henry)

Is that agreed? Agreed.

Senator Sean D. Barrett

I welcome the Minister to the House. I also welcome the contributions of the other Senators. The Minister referred to the importance of protecting patients and citizens. This is absolutely vital and I share his concerns in this regard.

The NTMA annual report shows on page 29 that at the end of 2010 the State Claims Agency had clinical claims outstanding of €786 million. This refers to 1,935 cases at almost €400,000 per case. If it is divided among the 7,000 medical and allied dental personnel in the health service it comes to €112,000 for each member of that staff. Reducing claims, providing indemnity and improving the safety of the health service, measures for which the Minister has put before us are necessary. This is a huge expense which I am sure the Minister and his colleagues at Cabinet, Deputies Howlin and Noonan, are also examining. I welcome this aspect of the Bill as there is such a level of claims against the health service, as notified by the NTMA annual report, that we must act . I commend the Minister for so doing. This is the major point I wish to make, that promoting safety and higher standards, particularly where the costs are so huge as the NTMA report shows, is a very important function. I commend the Minister for this.

I welcome the fact that, as Senator Burke stated, the National Council for the Professional Development of Nursing and Midwifery supports the legislation. It is very important that we have this. I also welcome the consumer aspects of the Bill. There are some minor aspects I will refer to on Committee Stage. There is a requirement for retirement at age 65 for officers of the board. This appears to contravene the IMF-EU-ECB agreement where as a society as a whole we have agreed to raise retirement ages. I referred this back to the Minister to see whether what he proposes is compatible with what we have agreed at national level.

Since 1985, the key development which has taken place in the sector is the recognition of nursing as a degree qualification. Perhaps I will suggest later to the Minister that he includes the deans of medicine and the degree-awarding institutions in his goal of increasing, maintaining and promoting professional competence. If these degrees are awarded then the degree-awarding bodies have a function to advise the Minister and his successors.

The Bill proposes that the Minister for Finance will give permission to borrow for current and capital purposes. I wonder whether the Minister for Public Expenditure and Reform should also be invoked in this. It has happened in other legislation which has come before the House. At this time we would be reluctant to think borrowing for current purposes by a State body is a good idea when we are facing so many problems with it at a national level and so much national effort is being put into bringing the national finances back in order.

These are minor points. We have a safety problem in the health service, which costs an estimated €786 million. This is a vast amount of money, and measures to improve professional standards and competence, to provide indemnity and to protect the public against unauthorised practices of midwifery and nursing deserve our support. I commend the Minister for bringing forward the measure.

Senator Feargal Quinn

It has been very interesting to hear the Minister and what he is trying to achieve with the Bill. I do not envy him his task because it will cost money. I note the Irish Nurses and Midwives Organisation has warned that patient safety is being jeopardised. The area of midwifery is of particular concern.

I draw the Minister's attention to the director of the Mid-Staffordshire Health Service in the UK, Mr. Mike Gill, who was very concerned about cuts in patient care and a number of investigations were carried out between 2008 and 2010. Mr. Gill spoke about how initial achievements in meeting financial targets were overshadowed by a dramatic fall in the standard of care which it is estimated led to approximately 400 unnecessary deaths. We must ensure the same thing does not happen here. I am aware the Minister does not have the amount of money he would like to have.

I also draw the Minister's attention to another situation in Britain whereby Diageo sponsored alcohol warnings to potential mothers. Ms Anne Milton, the UK Parliamentary Under Secretary of State for Public Health stated that midwives are one of the most trusted sources of information and advice for pregnant women and that the pledge by Diageo was a great example of how business can work with NHS staff to provide women with valuable information. People will ask why Diageo which is a drinks company should help people to drink less but it is a reminder that perhaps other sources of funding are available to help ensure that we achieve our aims.

We have a strong nurses' body here. Recently, I was in Greece and I was frustrated at the number of strikes taking place, with various strikes held on Sunday, Monday, Tuesday and Wednesday. People there said to me that we seem to have managed it well in Ireland. However, on my return it was announced that one of the hospitals in the south of Ireland was going to close for four hours because of objections to the number of people on trolleys. It is frustrating to think that people believe they can solve things in this manner. We must put our heart into this.

I know what the Minister is attempting to do, and as everyone here has stated we fully support it. Let us ensure we get it right, however, and that the cuts we must have will not impinge on the successful efforts the Minister is making in this area.

Senator Catherine Noone

I am glad to be present to support this Bill. I commend the Minister and his Department for the work that has been put into the legislation. The Bill includes a number of provisions that represent positive progress in the field of midwifery. I also commend my colleague Senator Leyden on his balanced and experienced approach to this matter. It is good to hear him being so positive.

Senator Terry Leyden

I thank Senator Noone.

Senator Catherine Noone

This new legislative framework will allow for greater protection of the public in their dealings with nurses and midwives. In addition, the Bill protects nurses and midwives themselves. I have worked in the area of medical negligence, and the Minister will be pleased to hear that it was invariably on the defence side. It is very important that midwives are properly insured and indemnified. It will thus be much easier to defend all cases because they will be properly regulated and represented. It is an absolute no-brainer that this Bill is more than welcome. Similarly, the recognition of midwifery as a profession in itself, distinct from other medical specialties, is most welcome. In addition, the Bill provides for the clinical supervision of midwives who must have adequate indemnity insurance and allows us to prevent potential difficulties from occurring, which surely is the job of Government in this field.

While there can be no doubt that midwives do a wonderful job every day, we must ensure we have adequate oversight in case any incidents should occur. As such, an improved investigation mechanism for complaints about nurses or midwives seems like a positive and appropriate step. Moreover, it is praiseworthy that this mechanism is being put in place as a proactive step, rather than being reactive, which things regularly are. While I understand that some of these rules add complexity to the profession of midwifery and add complications for midwives practising independently, I feel these standards and rules are the very least that the profession deserves.

I am also glad to see the introduction of the registration of nurses and midwives, as well as the registration of candidates. This step will increase oversight as well as increasing the identity of midwives as a separate profession.

I am glad to support the Bill. I congratulate the Minister and his Department on their work.

Senator David Cullinane

I welcome the Minister to the House. A Senator who has jut left the Chamber, has on a number of occasions mentioned strike action in the hospital concerned. Of course, strike action is a last resort but it is open to workers in this State to withdraw their labour. We should concentrate on dealing with the issues as to why people go on strike in the first place. We know that many health professionals work in difficult circumstances as the vanguard of the medical sector. Despite this, they are in the front line for many of the cuts we have seen in the health service. That is what motivates many people to engage in strike action if they feel their issues have not been addressed. The right to strike is enshrined in the fundamental European rights that were sold to us in the context of the Lisbon treaty.

This is an important and long awaited Bill. New legislation to replace the Nurses Act 1985 was recommended by the Commission on Nursing in 1998. In 2001, the government's health strategy, Quality and Fairness — A Health System for You, promised that: "Provisions for the statutory registration of health professionals will be strengthened and expanded." We have been waiting many years for such a Bill to be presented. I give credit to the Minister for introducing the legislation. The Bill contains important aspects for the statutory registration and recognition of midwifery. There are many provisions in the Bill that I support. However, Sinn Féin has some concerns about the Bill, which were articulated in the Dáil when the measure came through the Lower House. Unless these concerns are assuaged by the Minister, we are unlikely to be able to support the Bill in either House, notwithstanding the importance and value of many of the provisions therein.

It is important to put the Nurses and Midwives Bill in context. We had a lengthy discussion with the Minister recently concerning the perpetual crisis in the health service. Many issues were raised by Senators on that occasion concerning, for example, the recruitment embargo and its impact on front-line services. In addition, hospital ward closures were raised. We have seen closures of accident and emergency units and hospital wards, which put severe pressure on neighbouring hospitals without additional resources being allocated to support this increased demand. Senator Leyden cited the example of Roscommon but there are other examples throughout the State.

The people on the front line who have to cope with the outcome of the cuts in patient care are the nurses and midwives we are discussing now in the context of this Bill. They are bearing the full brunt of the cuts and are trying to manage a difficult situation. They are, however, hampered by a fundamentally flawed system, mismanagement at Government and HSE level, cuts and also by the absurd recruitment embargo. This is a suitable occasion on which to commend nurses and midwives on their work against this deeply stressful and high pressure background.

There are some who would like to blame public sector workers for all the problems in the country. The Minister will be aware that many people outside the political system have been on a crusade against those in the public sector for a long time. They seek to convey the idea that everyone in the public sector has been cushioned and pampered, but we know that is not the case. Many nurses and others who work in the health care system do difficult jobs in difficult circumstances, as I am sure the Minister will agree.

The problem is that consistently for many years — I am talking primarily about previous Governments — we have been holding many health care professionals back, including nurses and midwives. On a number of occasions in this House, I have said how absurd the current public sector embargo is. It is a blunt instrument, which has forced hospitals — some in my own city and county — to incur increased costs by having to use agency workers to provide support.

The Government moratorium on staffing in the public health service has seen the non-replacement of more than 1,900 nursing and midwifery posts. If the Government gets its way, the recruitment ban will continue and potentially a further 6,000 posts in the public health services will be lost in the next three years. In recent days, Sinn Féin Members have indicated to the Taoiseach that potentially another 3,500 acute hospital beds will be lost unless corrective action is taken.

The Irish Nurses and Midwives Organisation and the Community Midwives Association have been active in campaigning against the unjust cuts imposed on them, as well as the impact those cuts have on patient care, as I outlined earlier. They have proven themselves to be the most vigilant watchdog for the health care system, exposing malpractice, accident and emergency unit overcrowding and excessive waiting times. These are all issues about which the Minister spoke passionately when he was an Opposition spokesperson on health. I am sure he will agree with many of the points I am making. I recognise that the Minister has only been in his current role for a short period. I have put on the record my confidence that he will attempt to tackle many of the problems in the health service.

The INMO and the Community Midwives Association add to the debate and provide us, as public representatives, with information which otherwise might not be available, thus allowing us to hold the Minister and the HSE to account. On numerous occasions, I have dealt with the lack of accountability concerning the HSE. I know the Minister has policies in that regard.

It is clear that nurses and midwives are a crucial part of our health care system. Our chief concerns arise in relation to midwives, including many of the points which have been flagged by the Community Midwives Association. The enhanced recognition of midwifery is welcome. However, concerns have been raised that the representation of midwifery on the new board is not sufficient and, in particular, about the way in which the Bill addresses the legal requirement for indemnity for midwives.

There is concern that the Bill may not go far enough in recognising midwifery as a distinct profession. These issues of recognition and representation have been raised by the INMO and the Community Midwives Association. It is their view that the midwifery profession, in terms of the midwives committee, has not been properly recognised and provided for in this legislation. The Bill feeds into the view, rightly or wrongly, that if it is passed, the role of midwives will be undermined. The Community Midwives Association has concerns about sections 24 and 40, which I will deal with briefly.

There is a strongly held view that this provision could severely curtail the ability of women to have access to midwife-led childbirth. This has long-term implications for childbirth in this State, given the overcrowding in maternity hospitals and the loss of maternity units in different hospitals. The requirements for proper qualification registration, complaints procedures and sanctions, where necessary, are appropriate. I note also that section 86 outlines the duties of the HSE to facilitate education and training of student nurses and midwives, and the Bill will provide the legal basis for this, but from where will the resources come to enable that education and training to be provided? I accept this is a positive provision in the Bill, but the Irish Nurses and Midwives Organisation, INMO, and the Community Midwives Association have posed that question. It is all right to have such a provision, but will the resources be forthcoming? Will the Minister assure us categorically that he will be able to provide the appropriate training and education places?

Acting Chairman (Senator Imelda Henry)

Will the Senator conclude his contribution?

Senator David Cullinane

We have concerns about this Bill. I did not have an opportunity to speak on all our concerns because of time, but I hope to deal with them on Committee Stage. I commend the Minister on making some moves in this very important area.

Minister for Health (Deputy James Reilly)

I thank all Senators for their contributions and the general sense of support for this Bill. I will deal with the issues as they were raised.

Senator Leyden made some very valuable comments and I assure him that while I disagreed with much of the previous Minister's policies and actions, I did not disagree with all of them. The Senator mentioned the issue of a member of a local authority not being allowed on the board. As this was addressed by an amendment tabled on Report Stage in the Dáil, it will be possible for a member of the local authority to be on the board.

Senator Terry Leyden

I have a copy of the Bill as passed by the Dáil. Has it been changed since it was passed by the Dáil?

Deputy James Reilly

I am given to understand that it was amended on Report Stage.

Senator Terry Leyden

When I asked for the Bill, I should have been given the Bill as passed by the Dáil. I apologise to the Minister.

Senator Catherine Noone

That is not the Minister's fault.

Deputy James Reilly

I am sure there is an explanation for that, but let me assure the Senator that the prohibition was removed.

Senator Terry Leyden

I accept his assurance and thank him for changing it.

Deputy James Reilly

I was never a member of a local authority but I did have the honour of serving on health boards, the NHA, the Eastern Regional Health Authority, ERHA, and the Eastern Health Board, EHB.

I am supportive of an outreach service for Roscommon County Hospital. I would go further and say I would prefer the outreach service to be in a primary care centre in Roscommon town. We want to bring the services as close to the patient as possible. As I have said before, we want to have patients treated at the lowest level of complexity that is safe, timely and efficient and as near to home as possible. One cannot get much closer than home delivery of babies. We did point out, however, which the Senator acknowledged, that we must ensure the service is safe and that those who are at risk are advised of that and encouraged to attend a hospital rather than have a home birth. We will be expanding the range of services at Roscommon County Hospital and that will become apparent as time passes. Since I was last in the House, plastic surgery outpatient and day case services have commenced, rheumatology is due to commence and other services will start in the new year.

The issues that Senator Burke raised are in the main addressed in the Bill. We will certainly look at the wording that was a cause of concern to Senator Gilroy. He was concerned that there is a doctor on the board, but one medical representative out of 23 members hardly undermines the nursing profession. Indeed there is a nursing member on the Medical Council. Senator Gilroy was also concerned that self-employed community midwives would not be able to sign the memorandum of understanding close to a hospital.

Senator John Gilroy

No, the point I was making on the memorandum of understanding relates to clinical supervision. If there is no suitable locally based supervisor in an area, which may apply in a particular area peripheral to Dublin, those independent midwives would not have clinical supervision available to them and therefore would not be able to operate as an independent community midwife.

Deputy James Reilly

I will address that point. Of course the memorandum of understanding is available to all community midwives who can abide by its terms and conditions. The issue of supervision is of significant importance and it would not be safe to allow people to take off on a career without further continuing professional development. That is an area we have sought to address in the medical and nursing profession as well as in other professions. I think that is good.

Senator Barrett spoke about promoting safety to reduce costs. We absolutely share his views on safety to reduce costs as well as our primary concern to reduce harm to unborn and new born children and women.

The compulsory retirement at 65 years for those who work for the board relates only to those who have been with the board before 2004. I do not think it applies to personnel employed since 2004. I am very open to that issue because I do not believe in ageism. One's ability to work should be based on competence, not on chronological age. Many people under 65 years would not be half as competent as some of those over 65 years. I would be the first to put up my hand.

Senator Quinn asked that we ensure the cuts we must make because of the economic mess we have inherited do not make hospitals unsafe. It is certainly our intention to make hospitals safer.

I thank Senator Cullinane for his expression of confidence in us. It will not be from lack of trying and effort that it will not happen, because we will give it everything we have got. We have gone further and, with the special delivery unit, we are now getting an analysis of what is going on in our hospitals. We can see where problems are arising, where we are not succeeding having taken measures, and where we can take further action. I concur completely with the Senator that industrial action is a right that every worker should have, but it is hardly appropriate in a scenario where the service is under strain because it makes the strain worse. That does not seem to me to be the appropriate route to take.

Senator David Cullinane

The Minister should deal with the reasons for the strain.

Deputy James Reilly

I might also advise the Senator that it is outside the Croke Park agreement, which is very clear: no pay cuts, no industrial action, and vice versa.

The Senator mentioned resources for education. All the other professions are being asked to fund their own education out of their own resources. The taxpayer cannot be expected to continue to fund continuing professional development. That is the responsibility of the professional and will be increasingly the case into the future because the State does not have the money to fund it. The professionals themselves must do that.

It would be unfortunate if Senator Cullinane were to oppose the Bill. The phrase "throw out the baby with the bathwater" is particularly apt in this case as the baby will be thrown out with the bathwater, which would be unfortunate.

If I have not covered all the points raised, Members will remind me on Committee Stage where the matters can be addressed further. I thank Members for their contributions. The purpose of this Bill is to enhance the protection of the public in its dealings with nurses and midwives and this is the framework on which the Bill is based. I continue to emphasise this point as it is at the core of the provisions of the Bill and the concerns of Members. I look forward to the Committee Stage debate and the passage of the Bill.

Question put and agreed to.

Committee Stage ordered for Wednesday, 23 November 2011.

Sitting suspended at 5.50 p.m. and resumed at 6.10 p.m.