Commencement Matters

Periodic Payment Orders

I welcome the Minister of State. I raise the issue of legislation relating to periodic payment orders in the context of a recent presentation made to the Oireachtas Joint Committee on Health and Children by a parent whose child was severely affected by medical negligence. It was clear at the time of the child's birth that she had been badly affected by the manner of her delivery but it was nine years before any payment issued to the family. The parent spoke about the fact that the first three to four years of that child's life were extremely important but that the family did not have access to funding to provide the best possible care for the child. I raise this matter in that context.

In a recent case at the same hospital a settlement was reached at a far earlier stage - approximately three years after the event. At least there was some satisfaction from the parents' point of view then because they knew that moneys would be available to allow their child to access the kind of services needed at a very young age. This is a very important issue and we should introduce the appropriate legislation as soon as possible.

The Minister for Justice and Equality, Deputy Frances Fitzgerald, regrets that she is unable to be present for this discussion. She would like to thank the Senator for raising this important issue which gives her Department the opportunity to outline the progress made in the introduction of periodic payment orders in cases of catastrophic injury.

It is fair to say there has been much debate in recent years on the appropriateness and accuracy of lump sums awarded in cases of catastrophic injury. Assessing damages in such cases is difficult, given the uncertainties involved in making assumptions as to the person's future circumstances as well as issues such as investment returns and inflation rates. The President of the High Court, Mr. Justice Nicholas Kearns, established a working group on medical negligence and periodic payments in February 2010. The group's terms of reference included considering and reporting on whether certain categories of damages for catastrophic personal injuries can or should be awarded by way of periodic payments orders, PPOs, as opposed to once-off, lump-sum orders and to make recommendations and provide draft legislation, regulations and rules as may be necessary. In the course of its deliberations the working group extended its examination to all personal injuries, not just medical injuries.

I am sure the Senator is aware that in many other jurisdictions catastrophic injuries cases are compensated by PPOs which avoid the possibility of over or under compensation, as such payments are tied to actual costs of treatment and actual duration of life. This is not the case in Ireland where the lump sum approach to assessing damages in catastrophic injury cases has been the norm. This approach has been criticised in that lump sum payments can lead to situations where the lump sum is exhausted before the demise of the claimant. Alternatively, if the claimant dies unexpectedly, the remainder of the lump sum becomes, in effect, a windfall for his or her family.

It is the Minister's belief that the introduction of an appropriate and effective scheme of PPOs will address the issues raised by the working group on medical negligence and periodic payments and will further the interests of justice. She is also of the view that a PPO scheme together with other legislative changes, such as the introduction of pre-action protocols for medical negligence, will have positive impacts on high medical insurance costs.

It is vital that any such scheme ensure the continuity of payments to the plaintiff. Where the State has such a liability, security of payment is not an issue. However, in the case of private defendants, usually an insurance company, the matter is more complex. It will require the establishment of a financial infrastructure to ensure continuity of payment, while ensuring the State's position under any such scheme is well protected.

In 2013 the Government approved the drafting of the heads of a civil liability (amendment) Bill to implement the recommendations contained in the High Court working group report on periodic payments orders in personal injury cases with respect to awards made against the State and agreed that the extension of any such scheme to non-State defendants would be examined further in consultation with the Department of Finance. Subsequent to the Government's decision, the Department of Finance, through the State Claims Agency, commissioned an actuarial study of this issue. Following receipt of the study in April 2014, the Department of Justice and Equality established an interdepartmental working group to work through the technical aspects of the issue and devise the elements of the periodic payment scheme for the proposed legislation. In particular, the group examined the following issues: financial security mechanisms for PPOs for both State defendants and private defendants; the indexation of PPOs - the group examined the most appropriate indexation measure for inclusion in the legislation; variable or stepped PPOs; a variable PPO would allow parties to return to court to seek a variation of the order in certain circumstances, while a stepped PPO would include at the making of the order a number of stepped payments to cater for specific milestones in a claimant's life; the extent to which decisions to award PPOs should be mandatory or at the discretion of the court; and the scope of a PPO scheme - whether it would, for example, include both State and non-State defendants. The group has completed its work and made a number of recommendations on these technical issues.

The Minister for Justice and Equality, in conjunction with her colleague, the Minister for Finance, is actively considering the optimum implementation mechanism to ensure the financial security of PPOs. The Minister has informed me that she expects to be able to bring the necessary legislative proposals to the Government in the very near future, with a view to the necessary legislation being published and enacted this year.

I thank the Minister of State for his extremely comprehensive response. I appreciate very much the work done by him, the Minister and their officials in preparing it. The legislation is the way forward and something we should put in place at an early date. I know, however, that the Minister of State cannot give a timeline. However, will we see the draft legislation before the summer recess?

On behalf of the Minister, I apologise that she was not able to attend to participate in the debate. Within the answer she has clearly indicated that it will be done by the end of the year. The Government has given an undertaking that it will bring forward legislation during that period and fully intends to honour its commitment. It is the Minister's view that any scheme that introduces PPOs should be extended to cover cases in which the defendant is not the State. Having said this, the Minister believes one must recognise that in the introduction of a scheme covering all defendants we would have to ensure the State would not be exposed to unnecessary financial risk. I am sure the Government would not be thanked if we were to expose the country to financial risk in this way. It is clear from the Minister's answer that she is determined to ensure this matter will be dealt with within the year. I presume, although I have not discussed this with the Minister, the legislation will be presented to the relevant committee first.

Home Repossession

I raise the important issue of repossessions that are happening around the country. There is a huge number of repossession cases, thanks mainly to the enactment of the 2013 conveyancing Bill. It was very unfortunate legislation which I was happy to vote against. As it in place, I want to make sure it will work in some way and give some relief to those who face repossession, particularly of the family home.

Last Monday in County Meath 84 cases were listed to be heard by a very good county registrar but not a judge of the Circuit Court. I have a problem with this, but not out of disrespect for individual country registrars who are very good people. However, in a case in which a property is at risk or a family home is about to be repossesed by the bank, it strikes me as completely wrong that it will be presided over by a country registrar, not a judge. In general, the county registrar's role relates to procedural and other limited issues which are dealt with as a matter of course. The repossession of a family home is, however, a crisis, catastrophe and disaster for the family concerned.

Article 37 of the Constitution states some judicial powers can be delegated to non-judges, but it talks about the delegation of limited functions and powers, not repossession of the family home. In addition, the conveyancing Act, of which I am so critical, at the very least, requires and specifies that cases should be decided by a judge of the Circuit Court. It is completely wrong, therefore, that judges are not presiding over such cases. If a judge was present, there would be greater formality and the process might be slowed, which would be good because it would give people a chance to keep the family home, which is what we are trying to do. If a judge was to hear a case, it might slow it down and there might be more discretion. From what I can see, county registrars have very little discretion and the lists are regarded as completely routine.

What is frightening is that the people concerned, some of whom are before courts today in Dublin, were before the courts in Trim, County Meath and Dundalk, County Louth last Monday and will be in Cork next Monday, are mainly unrepresented. They are not represented by lawyers because they cannot afford them. Perhaps they are ignoring the matter because they are so scared and the issue is so traumatic for them, but they are about to lose the family home, yet this is being seen by the State as an administrative function of the courts and not treated as the catastrophe that it is. County registrars do a good job and I am in no way critical of them individually. Outside Dublin and Cork the county registrar also acts as the sheriff. That means they make an order for repossession and then, if the bank wants to do so, execute it. This is in breach of the concept of a separation of powers. We must call a halt to this practice. The Circuit Court needs to get its act together. Let us look at the legislation in place, specifically the 2009 Act which was found to be flawed and the 2013 Act which specifically mentioned a judge of the Circuit Court, as it is about time judges heard these cases and had way more discretion. There was this nonsense in the conveyancing Act of referring cases to a personal insolvency practitioner, but that is not enough because judges need to look at all circumstances of a case. There was some discretion used in one case in the High Court last week, but that was a ridiculous case which had continued for 15 years or so. The Government needs to give people a chance and state, "enough is enough; let us try to keep people in the family home; let us try to give them a solution, and let us try to stop the avalanche that is about to hit us."

On behalf of the Minister for Justice and Equality, I thank the Senator for raising this important matter. The Minister regrets that she is unable to be present for the discussion.

As the Senator may be aware, the county registrar is a legal professional officer of the Circuit Court. A person appointed to the role of county registrar is highly qualified and, for example, must have practised for at least eight years as a solicitor or a barrister. The powers of the county registrar are set out in primary legislation as approved by the Oireachtas, including in the Courts and Court Officers Act 1995, as amended. Under primary legislation and court rules, county registrars are empowered to deal with many types of motion. This is intended to maximise the potential of the office, while at the same time facilitating improved efficiencies by freeing the judges of the Circuit Court to deal with the substantive aspects of proceedings. The role of the county registrar in this regard is defined and not a substitute for the constitutional role of a judge.

In regard to possession cases, in very specific circumstances, where an appearance has not been entered or an affidavit setting out a defence has not been filed and delivered, the country registrar may make an order for possession.

This power to make an order for possession on foot of a registered charge or a mortgage of unregistered land in these circumstances has been given to the county registrar by primary legislation under section 34 and Schedule 2 to the Courts and Court Officers Act 1995, as amended. The procedures applicable to repossession cases in the Circuit Court are governed by rules of the court. The Senator pointed this out. The county registrar, in addition to the power to make possession orders as outlined above may also make an ancillary order, such as an order of service of the Civil Bill on any other party; adjourn an action to another date; make an order enlarging the time for entry of appearance; give directions and fix time limits for the filing and delivery of any further affidavits by any party or parties; and give any other directions for the preparation of the proceedings for trials.

These proceedings must be commenced by a civil bill. The Senator may wish to note that in 2014 a total of 8,164 civil bills for an order of possession were lodged in the Circuit Court. As the Senator will appreciate, if all of these cases were to heard by a member of the Judiciary it would have significant resource implications for the courts. The specific role of the county registrar in regard to possession cases provides for a speedier and more efficient administration in respect of particular aspects of court business and frees up judicial time for the hearing of the substantive matters. It can also contribute to reduced cost of proceedings.

Where an affidavit setting out a defence has been filed, the county registrar transfers the civil bill, when it is in order for hearing, to the judge's list at the first opportunity. The county registrar is not empowered to dispose of the matter in these circumstances and it must go before a judge in court. Furthermore, under section 34 of the Court and Court Officers Act 1995, all orders of a county registrar are subject to appeal to the Circuit Court. The courts are, subject only to the Constitution and the law, independent in the exercise of their judicial functions and the conduct of any court case is a matter entirely for the presiding judge. The Senator will be aware that this Government has put in place a number of legislative provisions regarding protection of the family home in cases where repossession of the property is being sought, most recently in section 2 of the Land and Conveyancing Law Reform Act 2013. The Government has provided an enhanced range of information and guidance services for mortgage holders, including a dedicated information website, a mortgage arrears information and advice helpline and the provision of independent financial advice for mortgage holders who are being presented with long-term mortgage resolution proposals by their lenders. This advice is provided by qualified accountants drawn from members of the main accountancy institutes in Ireland who have agreed to participate and support this independent service. I would encourage people to avail of this service, where appropriate.

I presume the Senator has encountered many people who are distressed and pressed by the bank but in many cases - I would be interested to know the Senator's view on this and the number of cases he is dealing with - people have failed to engage. Sometimes the first person they engage with is either a Senator or a Deputy. I urge people to engage with their lenders as much as possible in the first instance. I again thank the Senator for raising the issue and apologise that the Minister could not be here this morning.

I am angry, not with the Minister of State but the Minister for Justice and Equality. The idea that the excuse for county registrars handing out repossession orders and kicking people out of their homes is that there are too many cases and if we got judges involved, the system would not be able to cope. That is effectively what the Minister of State has said - the system could not cope if we got judges to hear all these repossession cases. It is an extraordinary admission by the Government. It is making me angry and I am sure it is making people angry across the country. Some 8,164 civil bills for an order of possession were lodged in court. If all these cases were to be heard by a judge it would have significant resource implications. The Government is saying this. It cannot handle the number of repossession cases, the number of families being kicked out of their homes; therefore, it is asking civil servants - registrars, who are not judges - to do this instead. It is wrong.

The vast majority of people on the repossession list are unrepresented. They do not know about entering an appearance. They do not know what it means. They do not know what delivering a defence means. I know of one person who entered an appearance and thought he had to appear in court the day after he got the summons. It is a document, but how are people meant to know that? To them it is gobbledygook. We need judges hearing these cases and showing sensitivity and we need the Government to admit there is a huge crisis. Above all, we need to keep people in their family homes.

The response by the Minister of State to the matter I have raised is extraordinary. I hope he goes back to the Minister and points this out to her. I cannot believe any politician could stand over what was set out in the script he read.

I am also very angry, considering the financial mess we inherited in this country. It is easy for Senator Byrne to stand up here-----

The Government brought in the law allowing repossession.

The Minister of State to continue, without interruption.

I did not interrupt the Senator. It is not nice to be reminded of how Fianna Fáil left this country. I know the Senator gets angry when reminded, but we have had to tidy up this mess. Any order made by a county registrar is subject to appeal to the Circuit Court. There are no plans to amend the current legislation. The Senator showed a little fake anger. It is a pity his fake anger-----

I was working on this issue before the Minister of State was ever in these Houses.

It is a pity his anger was not there when Fianna Fáil was bankrupting the country.

I wrote a report on this in 2009, before the Minister of State was ever heard of.

Special Educational Needs Staff

I welcome the Minister of State at the Department of Education and Skills, Deputy Damien English.

I welcome the Minister of State back to the House.

This issue was brought to my attention by a constituent of mine who, to be fair, has engaged in further education in order to better herself, her prospects, her opportunities and her contribution to society. She finds herself caught between a rock and a hard place in terms of the existing career break structures. She is currently employed as a special needs assistant, SNA, in a school in County Clare and wishes to finalise her degree. Unfortunately, were she to do what is required in that regard she would have to take an unpaid career break and, more worryingly, would most likely have to resign her position.

I am asking for the relevant circular dealing with this kind of issue to be interpreted in a flexible manner. Each situation is unique. As a society, a state, a Department and a Minister, we need to equip people to further their education. When people show good faith in doing so, exceptions can and should be made in certain circumstances. The criteria should be good faith and goodwill towards somebody who demonstrates clearly that they have engaged in the education system in order to better themselves and improve their skillset. Once that is demonstrated, the Government and the Department of Education and Skills should be working with people in a positive manner to resolve problems they may find that the system, through bureaucratic necessities, has created. I want to see a positive disposition from the Department, where it will look at an individual case in its totality. Where bureaucracy is becoming an impediment to somebody bettering themselves, that bureaucracy should be looked at in a looser fashion, whereby the individual concerned would be able to finish her studies without it having a negative impact on her present employment. Who would give up a job, with the security that brings, to take a leap into the unknown? Although this person will be better qualified when she has finished her degree, she will not necessarily get a job. We all know that one requires a job to live and to play an active role in society. It is a complex and difficult situation, but I hope the Minister might be able to identify some flexibility so that this person will be able to achieve her goals.

I thank the Senator for raising this matter as it provides me with the opportunity to outline the position on the career break scheme for special needs assistants in recognised primary and post-primary schools.

Special needs assistants, SNAs, are recruited specifically to assist in the care of pupils with disabilities in an educational context. They may be appointed to a special school or a mainstream school to assist school authorities in making suitable provision for a pupil or pupils with special care needs arising from a disability. The first priority is that the care needs of the children are met on an ongoing basis during the school year.

In June 2012, my Department, in conjunction with the school management bodies and the relevant trade unions, agreed a career break scheme for SNAs in recognised primary and post-primary schools, the provisions for which are contained in Circular 22/2012. The scope and objective of the scheme is for employers, wherever possible, to facilitate applicants to take time off to engage in, for example, personal development; education, including teacher training; public representation; child care-dependant care; and self-employment. The scheme is not designed to cater for those seeking to take up other paid positions in schools.

Each employer, in consultation with SNA staff, shall develop and maintain a policy statement specific to the needs of the school in respect of the approval of career breaks. In drawing up this policy, the welfare and educational needs of the pupils shall take precedence over all other considerations and, while taking account of the objectives of the scheme, shall have due regard to the capacity of the school to meet its obligations to its pupils.

In the public service and Civil Service, employees are precluded from taking up employment in another Department or a body under the Government's aegis while on career break. In a similar way, an SNA on a career break is precluded from taking up employment in a school. I thank the Senator for raising the issue, but I do not have the details of the specific case. If he wants to give them to me, I will examine them to determine whether we can give any advice or direction. As he knows, the circular was agreed with the unions. I do not know whether the Senator's client is engaged with them, but the rule is the same across the board for everyone. It is a career break, not the opportunity to fill another position in the public service.

The issue is the definition of "career break". Sometimes, people take career breaks to develop their skill sets. While I understand to a degree the logic of the current position, flexibility should be considered in certain cases. To be frank, I do not know whether the lady in question has engaged with the unions, but I will recommend that she do so. I will get my office to e-mail the details to the Minister of State's office. Perhaps he might be able to identify a resolution to the impasse for this unfortunate lady.

I will certainly examine the details to determine whether there is any advice that my Department can give. The Senator will appreciate that I do not know the case, but the logic is that one should not take a career break from the public sector to fill another position in the public sector. I am not sure if this is exactly what is at issue in the Senator's client's case, but that is how it seems.

The scheme is right. It would not make much sense to fill a job in the public sector while on career break and holding the other job. Perhaps there is more in the story, as I am not familiar with it. By all means, I would love to see the details and go through the case. If we can give any advice or direction, we will do so.

Gabhaim buíochas leis an Aire Stáit.

Nursing and Midwifery Board of Ireland

I welcome the Minister for Health, Deputy Leo Varadkar.

I am sorry if I have delayed the Minister. As he knows, we have a professional relationship as peers in this House, but in my day job I work for him. I was a little tied up this morning, delaying my getting here.

What are the contingency plans of the Department and the HSE in the event of the apocalyptic scenario of the great majority of the nurses in the country finding themselves unregistered in approximately six weeks time coming to pass? Without boring the Minister with details with which he is familiar and that he has responsibly been trying to deal with, the nurses feel aggrieved that their registration board has recently asked them for a 50% increase in their registration fees, amounting to an 80% increase in the registration fee over two fee cycles. The nurses feel aggrieved because they correctly believe that they have suffered disproportionately among their peers the ravages of the recession, both in economic, take-home pay terms and in quality of work terms. They have been asked and risen to the task bravely of stepping up and taking on an increased burden in what the Minister honestly admitted recently was a health service that had been subjected to a cycle of cuts that under his stewardship has now thankfully come to an end. However, the reality is that, during that time, nurses saw their salaries decrease, their workload increase, a failure to replace nurses due to embargoes and the same tax and USC increases and water and housing charges that everyone faced. Their hard question concerns what they have been getting in return for the increased registration fee. The representations that I have received from many nurses were to the effect that they have not felt that the board has given them good value for the fee. I will not go into details or personalise the matter, but the board has had quite a few expenses that the nurses find difficult to understand, for example, public relations costs and travel costs, which I am sure were undertaken for entirely legitimate business by the board. The nurses' sense is that the austerity has not been well spread.

Under instruction from their organisation and with a high degree of loyalty to same, they have indicated that they will not pay the increased fee, but will instead pay last year's fee, which would have the effect of finding the overwhelming number of nurses unregistered by their board by some date in early April. I hope that this will not come to pass, but I would be grateful to know whether there has been contingency planning. I thank the Minister for attending.

The Senator did not hold me up, as I have just come from the Dáil. I am the full-time parliamentary spokesperson for the HSE on Wednesday; therefore, I will return to the Dáil and the Seanad at least once more today.

I thank the Minister.

I thank the Senator for raising this matter. As he may be aware, the Nursing and Midwifery Board of Ireland, NMBI, voted on 17 September 2014 to increase the annual retention fee of each registered nurse or midwife to €150 from €100. The annual retention fee in 2013 was €88. The registration fee is set by the NMBI, which is a self-funding organisation. I recognise that the board must meet its obligations within the financial resources available to it. At the same time, this demands that obligations are met on the most economic basis possible and all planned expenditure can be demonstrated as necessary.

It was made clear on the enactment of the Nurses and Midwives Act 2011 that the board would continue to be self-funding and needed to plan and cost how it would fulfil its legal obligations. Following detailed negotiations with the executive and board members in 2013, it was agreed in October 2013 that an initial one-off sum of €1.6 million would be granted by the Department to the board to cover its 2013-14 costs, but that the board would have to increase its income in 2015 to undertake its commitments under the legislation.

The staff associations have undertaken a campaign of non-payment in respect of the new annual retention fee of €150 and have advised their members to pay the 2014 fee of €100 instead. Any nurse who does not pay the appropriate fee may be removed from the register. If a nurse or midwife is removed from the register, he or she will not be permitted to practise from the date of de-registration. However, the commencement of any de-registration process is an administrative matter and at the discretion of the NMBI. The NMBI has advised that it is committed to making its best endeavours to resolve the impasse with the staff associations.

I met the president, vice president and chief executive of the NMBI on 29 January to discuss the dispute. I again requested that the board re-engage in discussions with the staff associations as a matter of urgency. I expressed my concern regarding the implications for the health service and patient safety should the current impasse over the annual retention fee continue. I have asked the board to arrive at an outcome that secures its minimum financial operating requirements and avoids a scenario whereby nurses may be removed from the register for non-payment of fees, with potential consequences for service availability and continuity of care.

Since meeting the board's representatives, I have been informed that it has engaged in discussions with the nursing unions with a view to holding further talks, possibly facilitated by a third party, on the means by which the board and staff associations might come to an agreement on the fee structure for the future. The NMBI has indicated that it will consider amending the fee at a meeting scheduled for 3 March. Furthermore, it has indicated that it will withhold issuing reminder notices to registrants until after the review takes place at that board meeting.

As of 12 February, 25,980 nurses had paid the full €150 fee.

An additional 8,000 have paid the €100 fee and some 30,000 have paid nothing so far. The 1,245 graduates of 2014 who registered with the NMBI and paid prior to December 2014 have registration certificates which are valid until the end of this year. I will continue to monitor the situation closely over the coming weeks and I again encourage all parties to take the necessary steps to reach a resolution to this issue. It should not be insurmountable. In the event of any nurses being de-registered for non-payment of the fee I am confident the HSE will take appropriate action to ensure that patient safety and continuity are maintained. As it appears that a process is under way involving a third party, it will not be the case that anyone will be de-registered in six weeks time. A process has to be gone through before any nurse is de-registered and that process has been suspended during the current talks.

I am very grateful to the Minister for his thoughtful response. Nurses believe right now that their only two interactions with the board are to be given their money and to be disciplined by them. They are not aware of any great service being rendered to the profession, in particular in the area of continuous professional development and they feel the board has not stepped up to the mark in that area. I am hopeful that the current potential crisis can be overcome but in the long term some serious thought should be given by the board to the whole portfolio of their activities relating to developing the nursing profession.

I am reassured that in the event of a large number of nurses being de-registered steps will be taken to ensure patient safety. There only seem to be three ways that can happen. The first is to somehow give the nurses who have been de-registered some administrative leeway to allow them to continue to work. Second, it can be achieved by hiring other registered nurses to strikebreak, though I am aware that is not necessarily the right word. Perhaps I should say "overcome the industrial dispute". Third, we can cancel procedures and decrease the workload per nurse. I understand there is a negotiating position but can the Minister give us a hint as to which way the specifics of the measures to ensure patient safety will lean?

The Senator knows this but it is important to say the main service the nursing and midwifery board provides is for the public and patients. It is not there to service the interests of nurses and midwives per se, nor is it a trade union or staff association. It exists to protect patients and ensure fitness to practise. It hears complaints, such as those against the nurses shown up in the "Prime Time Investigates" documentary on Áras Attracta. It does, of course, provide services to nurses, such as the documents they may need to travel and work overseas, and it is intended to bring in competency assurance as well but the main reason it is there is to protect the public and patients. It is not a nursing advocacy organisation. It is also generally well established that professionals should bear the cost of their own regulation. The fee nurses pay is higher than that paid by therapists but medical and surgical interns, many of whom earn less than nurses, pay more, at €310. Pharmaceutical assistants, who also earn less than nurses, pay over €200. The fee nurses are being asked to pay is very much in the middle range. Nonetheless, there has been a big increase and it has almost doubled in two years. It is legitimate for nurses to ask why this increase has taken place, how the money is being spent and whether it will keep going up. The nurses have reasonable concerns in this matter and I hope all the questions can be answered to their satisfaction and to that of the board through the current process. The HSE does have options and it is probably best for me not to speculate on which of the three or four options, or which combination of them, is intended but contingency planning is under way. Having said that, it is my expectation and hope this issue will be resolved as everybody wants it to be resolved without patients being endangered in any way.

I agree with the Minister and do understand the role of the nursing board but the best way to ensure safety is prospectively, not retrospectively. In Ireland we have too often followed the black box philosophy. We put structures in place to investigate health care disasters after they occur. If I may paraphrase an expression usually used in another context, it is the politics of the last health care atrocity. We need structures which prospectively prevent such disasters occurring. I believe the nursing board does have an advocacy role for standards in the profession and is not there just to inspect them after something happens. The money would be much better spent if the board used its efforts to ensure continuous professional education is developed.

I agree that the board also has a role in advocacy and it is not only concerned with fitness to practise One of the aspects of the legislation I am about to commence deals with exactly that subject, namely, competence assurance. There is, however, a cost associated with that and the cost will have to be met.

Sitting suspended at 11.15 a.m. and resumed at noon.