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Dáil Éireann díospóireacht -
Wednesday, 8 Nov 1950

Vol. 123 No. 3

Death of King Gustav V. - Nurses Bill, 1949 (Seanad)—Second Stage.

I move that the Bill be now read a Second Time. The object of this Bill is to establish a single body for the control of the different branches of the nursing profession, including midwifery. This body, to be called An Bord Altranais, will replace the two existing boards which at present control nursing in the country. In addition to carrying on the functions of the two existing controlling bodies—the General Nursing Council and the Central Midwives Board—the new body will have further powers. I should like to say at this stage that the establishment of this body does not arise out of any feeling on the part of the Government that the functions discharged by the existing bodies are not being extremely competently and efficiently carried out at present. It arises largely because of the changes which are taking place in relation to the nursing profession generally in the country, in relation to hospital services and the expansion of medical services. I think that most of us who have any experience of the nursing profession in Ireland are well aware that nothing but the very highest praise must go to these two bodies who have given us the opportunity of saying, in relation to the nurses turned out by our hospitals and institutions, that there are probably no better set of girls in such profession in the world. I believe, however, that in spite of the competency and efficiency of these bodies, a new body with wider powers should be established.

In addition to the powers at present exercised by the General Nursing Council and the Central Midwives Board, which were largely confined to the laying down of courses and the working out of syllabuses for training, we should like to extend the powers of this joint board to allow them to direct recruitment, to direct the training of nurses and to advise on the organisation of the nursing services. In addition, they will carry out the present function of the Nursing Council which relates to the approval of training schools. At present the council has no power to organise training. It is placed in the position that it can determine the quality of the nurses, which it has done extremely well, but it has no say in the numbers of girls who go for training. Similarly, the Central Midwives Board has functions in relation to midwives practically identical with those exercised by the General Nursing Council in relation to nurses. Naturally, the Central Midwives Board caters specifically for midwives but, in addition, due to the special type of duties carried out by midwives, the Central Midwives Board exercises certain disciplinary functions over its midwives. In these days, there has been a development whereby girls going for midwifery work usually have a background of general nursing training and we felt that if we could provide certain safeguards in relation to the midwives in a joint body—they would obviously be a minority in any joint body—it would be desirable to establish one body to control both types of nurses. That is what is proposed in this Bill.

In view, however, of these responsibilities in relation to disciplinary matters, disciplinary control over the practice of midwifery, and in order to try to maintain as far as we could the independence of the old Central Midwives Board, we have set up within this body a midwives committee and this committee will have exclusive responsibility to deal with all matters relating to the discipline of midwives. The main board must accept, in relation to disciplinary matters, the committee's decisions on all such matters as discipline in relation to the removal of midwives who have proved unsatisfactory. Incidentally, it is expected that other matters affecting midwifery will be referred by the board to the midwives committee.

Section 50 and 51 of the Bill empower the board to train nurses and to organise post-graduate courses. This is put in for a special purpose arising largely out of my anxiety to meet a considerably increased demand which I think will come as a result of the expansion of the health services, particularly in relation to the mother and child health service. There will be a considerable amount of domiciliary nursing work and I am anxious to ensure that a sufficient number of girls will be available with the necessary qualifications. The present position in relation to public health work per se in nursing is that most of the girls qualify in the ordinary way and take a number of post-graduate courses and then apply for public health posts. They are all of them, generally speaking, very highly qualified and naturally I have the greatest respect for their qualifications, but there is a certain lack of specific training in public health work as opposed to midwifery or general hospital work, and so on. I am anxious to rectify that defect by empowering this board to establish special courses in public health, domiciliary nursing, and so on. The training of nurses at present is designed primarily to make the girls first-class nurses for hospital work only. I feel that if we give this proposed board all the responsibility for organising these courses it will be a great step forward in relation to public health nursing generally.

Another very important point which we must bear in mind is that in the first place it is quite obvious from the very big hospital building programme which we have on hands and which must mature in anything from three to ten years that in relation to hospitals, health clinics, dispensaries and mother and child services, a very vast expansion in our requirements of specialised nursing personnel must be envisaged and consequently we feel that this whole question should be tackled now rather than wait until the shortage is upon us. I am glad to say that at present we have no real shortage of a type that would cause any worry. Many of the girls are coming back and working here, but as I say I think that the demand will increase and consequently, I feel it is only right that we should deal with that anticipated shortage now rather than face the position which I think they are largely facing in Britain—that they have the beds, that they have a number of hospitals, but that they have not got the nurses.

The Bill also envisages the establishment by this board of scholarships by collaboration or co-operation with other authorities such as universities and hospitals for candidates for higher administrative posts or specialised nursing posts in the ordinary way such as midwifery or general nursing. They should be empowered to organise post-graduate courses and provide for scholarships where there is a suitable girl who may not be able to afford the instruction which could be made available by this board in hospitals, universities, etc.

While I say that we can make very desirable improvements by virtue of this Bill, I am quite satisfied that it does not answer all our problems because I think that the main one probably arises out of the conditions of work of our nurses in our hospitals throughout the country. I think that one of the best ways in which we can anticipate effectively a shortage of nursing personnel is considerably to improve the standard of working conditions and living conditions of our nurses within our hospitals. In relation to local authority services we are at present doing everything in our power to provide for these desirable minimum conditions under which these girls may live, reasonable disciplinary control, good living conditions, separate rooms and good food, small things but things which make a tremendous difference in the anxiety of a girl to take up nursing or practise nursing.

I might add—a great number of Deputies may feel the point worth discussing—that I have no authority over the living conditions and working conditions of nurses working in the voluntary hospitals but in relation to local authority hospitals we are doing everything in our power to ally good working conditions, good living conditions and intelligent training conditions in order to anticipate the shortage which other countries already feel and which we fortunately are not yet experiencing.

The board will also have power under Section 54 to provide accommodation for girls undergoing training courses, and they will be empowered to charge for that accommodation, under Section 24. The constitution of the board is set out in Sections 11 to 13 of the Bill. It is provided that there will eventually be ten elected nurses on the board but, in order to get the new system working as soon as possible, the first appointment of the ten nurses will be made by the Minister. In addition, there will be 13 other persons nominated by the Minister—nine of them after consultation with appropriate bodies. Two will also be nurses which means, therefore, that, of the 23 members of this board to control, supervise and organise nursing training in the country, 12 will be nurses which, I think, is a very desirable point.

Naturally, the working out of the constitution of the board was a considerable headache, because of the various interests which might be anxious to secure representation. The Bill throughout has been drawn up in constant consultation with the different interests involved. The midwives committee will consist partly of doctors specially concerned with maternity work and partly of midwives. Some of these will not be members of the board, but liaison with the board will be ensured by having the chairman of the committee a maternity doctor who is also a member of the board.

In relation to the financial provisions of the Bill, the proposal is that the ordinary running expenses of the board on staff salaries, holding of examinations and so on, will be met by fees paid by the trainee nurses, but, in view of the power which we hope to confer on the board to institute scholarships, post-graduate courses and so on, other provision is also necessary. This provision is included in Section 59 of the Bill under which a grant will be made from State funds to meet balances of expenditure not met by the ordinary receipts of the board. The Minister, in turn, hopes to recover half of the amount of this grant from local health authorities in proportion to their population. It is proposed that any capital expenditure of the board will be met from Hospitals Trust funds.

This Bill has taken the unusual course of passing through the Seanad before coming to the Dáil. Many amendments suggested in the Seanad have been incorporated and I now recommend it to the Dáil as a measure which will help to ensure that our health services will not in future suffer from want of well-trained nurses.

We on this side give our approval to this Bill and I should like to say that I understand that the Bill has been in preparation since somewhere about the middle of the Great War. It was being prepared from about 1945 onwards, both under the Minister for Local Government and later under the Minister for Health who was in office before the present Minister. It is, as the Minister has said, in the nature of a co-ordinating Bill, co-ordinating the direction of all nursing activities, and should be an improvement on the present system. I should like to draw the attention of the Minister to some of the problems affecting the nursing world and the health of the country to-day. Some of these he has mentioned, but there are others to which I should like to draw his attention. I feel that the new board should do its utmost to improve the standard of the midwifery services of the country. While, on the whole, they are good, I think the standard of training needs improving, and I have heard stories, which I think are reliable, that the number of midwives in certain areas who know anything about anæsthetics is very limited. As the Minister is well aware, there is now a new type of anæsthetic which can be administered by midwives and I hope the new board will speed up still further training in regard to midwifery.

Secondly, as the Minister said, we have to secure a sufficient number of nurses, particularly in regard to certain nursing services such as tuberculosis, in which I understand there have been vacancies unfilled from time to time owing to the character of the work. Nursing is a very great tradition in this country, and, while we can be proud of the fact that the hospitals, both in the neighbouring island and in other places, are staffed by Irish nurses who receive the highest praise and while we are glad that it is a vocation which appears to be particularly suited to Irish girls, at the same time, we need to make sure that we have an adequate number of nurses for the profession in this country and I hope the Minister will carry out his promise to insist that that should be one of the first objects of the newly-constituted board.

The Minister perhaps could give us an idea of what the general position is in regard to staffing. It varies so much throughout the country that it is very hard to get a general picture of the degree to which the staffing is inadequate, due to insufficient numbers of persons applying and the extent to which that is due to the character of the services involved and the extent to which it is due to lack of facilities, lack of recreation or proper quarters for the nurses.

I should like to ask also how far the Minister has progressed with the plan which formed part of the new Health Act passed by the previous Government for the provision of dispensary nurses, highly trained, for every dispensary in the country, regardless of whether there was a public health nurse in the dispensary or whether there was a nurse from the Jubilee Nursing Organisation, paid for partly out of public, partly out of local and partly out of private funds. It was our idea that eventually every dispensary should have a dispensary nurse of the most highly-trained type to follow up the work of the doctor and to do work which no doctor can do in connection with mothers and children and to make sure that the after-effects of illness have been dealt with.

I want to ask the Minister also how far he proposes to direct this new board to consider the appointment of nurses for preventive training. During the course of the passage of the Health Bill under our Government, the Minister for Health adverted to that matter and pointed out that there was not half enough instruction and propaganda in relation to health and hygiene in the country and that the problem would have to be tackled. As the Minister knows, there are people who, through training in social science, acquire the gift of being able to impart information in a friendly sympathetic way and being able to give consideration to hygiene, cleanliness and other matters, all of which have been found necessary in other countries and which are equally needed here. It is a particular gift as well as being a matter of training and so far we have made very little progress in this country. We were hoping that the new Minister would carry on with the intentions of the previous Minister in regard to that matter. So far as I know, there has been somewhat of a delay and I should like to ask the Minister how far he is going to direct the new board to consider the problem of teaching preventive medicine to nurses throughout the country.

Then I come to the question of the improvement of conditions for nurses. The Minister adverted to the matter. Everyone knows that the conditions vary very much throughout the country and that they have improved considerably in the last ten years. From talking with members of the nursing community I understand, however, that a lot needs to be done yet.

Lastly, I should like to ask the Minister whether, in connection with this board, he will consider the present grant made available to the type of nurses paid partly out of central funds, partly local authority funds and partly private funds. I succeeded the other day in securing an increased grant for a particular nursing association and it occurred to me that perhaps the whole matter needed studying at the present time and that the board should direct their activities to that end as soon as formed. I know that in some districts the local association has great difficulty in finding the balance of the amount required to maintain the nurse. I know also that the nurses trained by the Jubilee Nursing Organisation are highly regarded and loved throughout the country and if something can be done to improve their conditions it will be a great advantage to the community. The pay of some of these Jubilee nurses seems to me extremely low in relation to that of voted services. In that connection, I should like to ask the Minister whether he will ensure that the Jubilee Nursing Organisation, and any other nursing organisation of that type, will play their due part in the developing and forwarding of the interests of this board.

As this is largely a necessary co-ordination of the various services referred to I think it is safe to say that the Bill will be welcomed by the House generally. The Minister stated that the proposals were largely the results of consultations with the various interests affected. That is a tendency in legislation for some time back in this House which is highly to be commended. He gave us to understand that the interests concerned were satisfied largely with the proposals and, if that be so, the Minister is to be congratulated.

I just want to put two points to the Minister which are ones of omission. Since this is presented as a measure of co-ordination, I am sorry that it has not taken a wider scope. I see no reason, for instance, why the nursing services in private nursing homes are not included. The House will have learned from time to time of the conditions that operate in these private nursing homes, and the fees charged there. That the private nursing homes should be excluded from consideration when there is what I might describe as a glorious opportunity to include them is a little disappointing.

The second omission is one anticipated by the Minister when he referred to the fact that he has no authority over the nursing staffs in the voluntary hospitals. That is a very sore question so far as public representatives are concerned. No one can say that the conditions of the nursing staffs under the local authorities are ideal—in a good many cases they are not—but, such as they are, both from the point of view of remuneration and conditions of service in some cases they set a very desirable standard. There is a very wide disparity between the conditions obtaining in the voluntary hospitals in the City of Dublin. When the Minister says that he has no power in the matter, I should like to ascertain from him when he proposes to take such power, because it is very badly needed. I regret that under these two headings the Minister did not see fit to avail of this opportunity to bring in these two sections.

As Deputy Childers stated, this Bill is welcomed by the House for what it contains and has been produced after many years' study of the matter by his predecessor as well as himself. I am not clear on certain aspects of it from the point of view of the actual technical details. The title of the body to be set up is "board". After reading the Bill and listening to the Minister, I have come to the conclusion that a better title would be "council" rather than "board", because certain of the functions of this board will be to a great extent similar to the functions of the Medical Council. I am not quite sure whether the Minister has made it clear to the House, particularly after Deputy O'Sullivan's intervention, whether all nurses, apart from all branches of nursing, are to be included under this board as well as all nurses taken on in the future, because if all nurses are to be included then, obviously, the nurses operating in private nursing homes will also be included. I should like if the Minister would make that clear.

Then there is another misunderstanding. Deputy O'Sullivan holds the view, as does the Minister, that even with the setting up of this board and the power he has already he has no power with regard to the voluntary hospitals. I do not agree with that. I think the Minister, not only has power with regard to the voluntary hospitals, but exercises it very frequently, not only so far as the voluntary hospitals themselves are concerned but so far as the local authorities are concerned. The Minister spoke of this board recruiting the personnel into the nursing profession. Here again we have a problem. The history of nursing in this country is quite peculiar. We have the mental institutions which recruit their own probationers to be trained to become nurses. Within the mental hospitals there are people set up to examine probationers, male and female, to see whether they have made sufficient progress to be qualified ultimately as nurses under the rules and regulations. The Minister has something to do with that. In the voluntary hospitals, a great number of which are teaching hospitals, there are certain requirements laid down. Certain types of persons are asked for in the first instance and from those are selected the individuals whom the particular hospital thinks will be most suitable to be qualified in the nursing profession and particularly in the institution that takes them in. Am I to take it that the voluntary hospitals and local authorities and private nursing homes will have to take their staffs from those who are registered under this board?

Might I explain to the Deputy? The recruitment of nurses will be carried on as it is being carried on at present. This new board will not recruit for a voluntary hospital or a nursing home or anything like that.

I understood the Minister to say that this board would be responsible for recruitment of personnel to the nursing profession. I think the Minister used the word "recruitment" in his opening statement just now. At present, the position is that the individual hospitals and institutions organise the recruitment themselves, and they have reasons for it. They want to pick certain types and, later on, they qualify the particular nurses. Am I to take it that recruitment by these institutions will have to be subject to this particular board's accepting these particular nurses, ultimately, on the register?

This board will lay down certain standards for syllabuses and courses for nurses in general hospitals and institutions generally. They will not actually recruit nurses at all themselves except where they are providing scholarships or post-graduate courses. They will lay down certain syllabuses—much as the general nursing councils do at the moment. It is a common course to all general hospitals which a girl will have to carry out before she can get her certificate from this board.

I should like to say that we are not opposing this measure.

I am sorry for interrupting the Deputy. I was merely trying to clear the point in the Deputy's mind.

I am not, even yet, quite clear on the matter. The Minister says that all interests have been consulted but I do not think he has stated—unless we can so conclude from the way he spoke—that all interests have indicated perfect happiness and satisfaction over the Bill. To what extent have the existing hospitals, voluntary hospitals as well as local authority institutions, expressed their satisfaction as a result of consultations with them? Different questions arise in connection with each hospital and in connection with each section of nursing. In a particular teaching hospital a very high standard obtains as far as nurses are concerned. One of the problems with regard to having sufficient nurses is due, if you like, to this double-edged situation. Qualified nurses from good-class hospitals in this country are very much sought after across the water. That, I think, is generally known. A very attractive proposition is made to nurses who qualify in first-class hospitals here, in the shape, in the first instance, of much better pay. Is it not a fact that a great deal of the complaint about the maximum rates of pay that can be accorded to nurses here is due to the refusal of the Minister—I will not say personally, but in his capacity as Minister—to allow institutions to increase their payments to certain types and grades of nurses? Apart from that, England recruits from this country a great number of our young people to be taught nursing on the other side because, again, even in the matter of teaching, much more attractive terms are offered to them.

We hear references to living conditions of nurses attached to very highly organised hospitals with excellent staffs of nurses. The Minister is aware that if the board of a particular hospital wants to spend a little money to improve the living conditions of their nurses by making better provision for their accommodation, the proposal is turned down. There is a new development which, I suppose, will be made known to a greater extent and that is the idea which is now in the minds of those who are the representatives of certain nurses that the living-in conditions should be, to a certain extent, remodelled and that nurses be allowed to live away from the hospitals and to go to their work in the same way as the ordinary business person goes to his business, and that the terms of their appointment should not include this living-in condition.

I take it that when the Minister refers to this board's laying down the conditions of training and qualifications, that that will also be done in consultation with the existing teaching bodies and in association with the Medical Council. After all, the Medical Council and the universities know, from the medical side, what is required and this board, I take it, will have to have some regard to that, in itself. When the Minister says, in regard to a local authority, that a person will have to have a certain amount of knowledge of public health requirements, I would point out that when a local authority seeks to appoint somebody who will have to attend to public health requirements, they specify in certain cases that certain people have to have a certain diploma or degree. It is quite common for people to take out a diploma in public health in our universities. Is this body going to be regarded afterwards as a body that will accord degrees or qualifications and will the local institutions have to take these degrees or qualifications at the same value as, say, those of a normally recognised teaching institution?

The Minister stated that this Bill is very necessary now that we are embarking on a large-scale hospital building scheme and that we should feel the draught in the matter of a shortage if we were not to take steps now. Between the years 1932 and 1939 we had a very big hospital building scheme and a number of hospitals were built in those years. I have already said that I do not think that rate of building will ever be equalled again in this country any time. The Minister is aware that I have promised to take off my hat publicly to him if, after seven years, he can show such a return as we were able to show in the period 1932 to 1939. Fianna Fáil, with the limited facilities and attractions available to our nurses at home even in those years, as compared with the facilities and attractions which obtained abroad, were able to fill the positions in most of our hospitals to satisfaction.

I want to say again from my own personal experience and knowledge and from long association with mental hospitals and with a number of our voluntary hospitals here in Dublin, that one of our great problems has always been to try to be able to offer as attractive employment conditions to our nurses as they were offered elsewhere. At one time in this country—the system has been changed now—a type of girl had to have a fee before she could enter a hospital for training and it very often meant that that type of girl was debarred because she had not the fee.

Is that not still the case?

I have said that that has been changed, to a great extent.

But not enough.

I agree. It should be abolished altogether. A great number of members of good families in this country who could not find the necessary fee to enable them to be trained —and trained under circumstances where they would still have to be supplied by their families with certain needs such as clothing, and so forth— have been debarred. We can easily get all our requirements met if, at the beginning, we remove the impediments in the way of people who are admirably suited but who have not got the £. s. d. and if we offer them attractive conditions of employment, even in the training periods, we will be removing one of the things which have militated against us in our efforts to keep the required numbers and to maintain at home the very best of our people who are snapped from us as soon as they are qualified. The Minister must see that this board will pay attention to these matters, apart from laying down the qualifications of nurses and the syllabus of studies.

I am somewhat confused. I do not know what the position of voluntary hospitals will be when this Bill becomes an Act and is put into operation. I hope the Minister will make that clear. There are certain voluntary hospitals who want to be in a position, not only to decide the qualifications that their nurses should have, but also to select their nurses from the point of view of character. The hospital authorities have a responsibility for their patients and they are entitled to pick and choose the individual nurses for their hospitals. I want the Minister to make it clear now, whether in time to come, the employment of nurses will be on what one might call a strictly trade union basis or not. I want to express the opinion now that it would be a pity if such a situation should arise because the personal touch enters into the relationship between the hospital authorities, the medical people attached to the hospitals and the nurses who are responsible from day to day and hour to hour for the patients. Therefore, some room must be left for individual decision as to the method of selection. I have no quarrel to find with the laying down of terms and conditions with regard to knowledge. I agree with Deputy Childers that in certain parts of the nursing profession there are people who make do, but who could have a great deal more knowledge.

I agree also with what has been said by a previous Minister that prevention of disease is much better than an effort to cure disease. In this connection, I want to relate an experience we had in the Dublin Corporation. There was a very serious scourge of gastroenteritis, with a very high mortality. After a great deal of examination by our officers and the local government officers, certain conclusions were reached. We decided to bring into our service additional nurses who were to do the very things that Deputy Childers has suggested, that is, to visit the houses and to instruct people in matters of hygiene, because we felt that one of the causes of gastroenteritis was lack of hygiene. We considered that 20 nurses were the minimum with which we could satisfactorily carry out this very extensive and important campaign in the City of Dublin. We were cut down to half that number. Prevention is a very important matter. There is no use in waiting until some scourge overtakes us and then trying to cure it and to eradicate all that it leaves behind. We have the position in regard to gastroenteritis well in hands now but, nevertheless, we feel that we should be given greater assistance both in permission to appoint and in relation to the financial assistance we get in our efforts to safeguard the health of our people.

This particular illness to which I have referred affects our infants in the first six months of their lives. We have had, for a great number of years, a considerable loss of infants as a result of that particular illness.

I will be anxious to read the reply of the Minister to this debate. I hope he will be able to clear up some of the points that have been put to him. I hope that when the Committee Stage arrives we will be better informed and advised in regard to general principles.

I believe that every section of the House will welcome the steps that have been and are being taken, though they may not be all that some of us might desire and may bring about some complications. Nevertheless, the idea underlying this whole arrangement is a good one.

This Bill gives us an opportunity of saying a few words in regard to nursing and the nursing service generally. I look on this co-ordinating Bill as largely in the nature of an experiment and I believe that, as a result of the working of that experiment, improvements, statutory improvements, amendments and perhaps a new Bill will come before the House.

Everything that has been said in regard to the treatment of nurses in the debate is, I am quite sure, well understood by the Minister. Girls adopting such a very important profession have been treated very badly. To a large extent, both during the period of their training and subsequently, they have been held almost as prisoners, subject to disciplinary regulations that were entirely out of date. If this Bill will result in an improvement of those conditions and in nurses being treated as they ought to be treated, then it certainly will be a good step forward.

There is no shortage of material in this country for the nursing profession. A very large percentage of our girls, particularly our country girls, are keen to become members of the nursing profession. Through rules and regulations in the past, very many who would have been excellent nurses were prevented from becoming nurses. Since the beginning of the last war, during the war and since, and particularly since the Government in Great Britain extended its health services, there has been a continuous flow of young girls to England to be trained. The conditions under which they are trained and under which they work after training is completed are much better than the conditions here. Better conditions will always attract and if we are to stop the flow of nursing material from this country and provide for the nursing staffs that we will require in a very short time, then it is vital that nursing conditions both in training and after training should be improved.

Young girls who adopt nursing as a career ought to be able to spend a considerable time in theoretical training before they begin to do practical work. Their hours of duty ought to be so arranged that individual nurses, and particularly young girls, will not be required to do, as they have had to do in Dublin hospitals, long stretches of night duty. In England a nurse in training has a half-day every other day and a whole day a week; their fares are paid to and from their homes; their laundry is free and they are paid a wage that enables them just to get along. They are required to pay no fee. When they qualify there is an offer of employment for these young girls at very reasonable wages and under very good conditions.

We must see that young girls who enter the nursing profession here are not treated as prisoners or as slaves. We must see that they get reasonable time to study, that there must be reasonable periods for lectures and theoretical training and reasonable hours of work. Further, we must see that their living conditions are improved, because the living conditions of many nurses in this country are very bad. Whatever little accommodation happens to be left in the hospital in a number of cases is set aside for the nurses—places in which patients cannot be put. Those are considerations that confront each and every one of us and I know that the Minister is aware of them and knows how essential it is that such conditions must be improved.

Deputy Briscoe has made a suggestion in regard to nurses being compelled to live in. There ought to be some reasonable freedom for nurses. Perhaps a number of them would prefer to live in rather than to live out, but it might be considered here in Dublin whether there should not be a central nurses' home, properly equipped, in which nurses might reside when they are not on duty in the hospitals. They would be free to a large extent from unreasonable restrictions; they would have the ordinary freedom and liberty of humans which, unfortunately, in the past was denied them.

In so far as this Bill is a step in the right direction, an experiment which we all hope will be successful, I am glad to see the welcome it is getting from all sides of the House. Perhaps if we were to keep up the drive through the Minister, we might succeed in improving the conditions of student nurses generally.

Maternity training has been mentioned. I understand that the maternity qualifications for Dublin hospitals are considered, and have been considered for many years, to be probably the highest in the world. Now, that is an excellent thing and I am sure the staffs of those hospitals are anxious to keep abreast of all modern developments. They have created a standard which is accepted in all parts of the English-speaking world, anyway, and I think we can trust them to maintain that particular standard and to avail of all fresh developments and any scientific aids that come along.

My only reason for speaking on this Bill is to give expression to the views I hold in regard to the mistreatment of nurses in the past and to express the hope that we are now at the crossroads and that we are moving forward in a way that will make those bad conditions to which I have referred only a memory.

Like Deputy Briscoe, I am very anxious as to the manner in which probationer nurses will be recruited. I would like that nothing will be done to take appointments out of the hands of the local people when it comes to the recruitment of such nurses. I think everybody will agree that it would be a bad thing if we were to hold examinations something like those held for the appointment of civil servants in order to get girls to qualify to become nurses. The manner of a girl, her attitude generally, has a great effect on the patient. In the case of local authorities or voluntary hospitals, they have their selection committees, which usually consist of the matron, the resident medical officer, the chairman of the committee or somebody else like that. These selection committees take into account, just as much as the educational qualifications, the manner and other qualities of the girl —qualities that they think will tend to make her a good nurse. That is a very important matter.

In the voluntary hospitals in Cork they have committees to examine the girls in the same way, and that system has worked very satisfactorily. There is another matter that we are very interested in in Cork and I hope this measure will provide some facilities in this direction. We are interested in registering male nurses. We had some male nurses in the Cork District Hospital but they were obliged to retire because of age. We heard very complimentary remarks from time to time from visiting surgeons with reference to the help given by those male nurses. There were aged male patients there who were treated better by a male nurse than they would be by a female. At the present time, the South Cork Board of Assistance are contemplating a scheme to appoint six registered male nurses and I hope this Nursing Bill will not interfere with that in any way. We have about three of the present attendants, who are very intelligent men, who would be described as male ward attendants and who will be recommended by the resident medical officer for these posts. They will have to do their lectures the same as the ordinary probationer female nurse and pass their examination. We are anxious at the present time that those who have given satisfactory service and who have carried out a lot of the duties which would be carried out in the ordinary way by probationer nurses, will be given facilities to go through that course of training and be allowed their present grade of pay during that probationary period. I hope this new board will not interfere with that in any way and that they will give facilities for a few young men, who will be entering the service, to undergo that course. In big institutions like the Cork District Hospital and St. Kevin's here in Dublin, it is necessary to have some registered male nurses.

It is also my own personal opinion that midwives should have a general nursing qualification. Many complications arise after childbirth that make such qualifications necessary. That matter should be considered seriously in regard to new people entering the service.

I believe we are not doing enough for our nurses. In the voluntary hospital in Cork they stay indoor, while in the district hospital they live outdoor, going to their own homes. They are not paid as they should be, nor are they provided with the recreation rooms and living accommodation they should get. I hope this board will look into these matters and will not interfere in any way with the recruitment of probationers.

Am I to understand from the Minister that nurses employed in the voluntary hospitals are not covered in this Bill?

This is only in relation to training, the conditions under which they qualify. That is included, but the conditions under which they live in the voluntary hospitals are not included. The board will have certain powers in relation to specifying the conditions under which the girls are trained.

It is not proper to call this a Nurses Bill if it does not include the conditions under which they live and their payment.

Section 51 allows the board to lay down conditions under which the girls are trained, in regard to both hospitals.

Yes, but once they are trained will the board have any jurisdiction over the conditions and the wages of nurses in the voluntary hospitals?

No. They can make recommendations in relation to the payment of nurses, but in relation to conditions under which they live it would be very difficult to train probationers under first-class conditions and keep the trained nurses living in indifferent conditions.

The Minister should look for power to include every nurse, in voluntary hospitals and private nursing homes, as the conditions, the hours of work and the wages paid to them have a tremendous effect in a country like this. I know of nurses in voluntary hospitals in Cork City—and it occurs in other places—who work ten weeks at night duty without a night off.

If those nurses are not included, they should be, and I hope the Minister will include them. I was looking forward to this Bill for a long time to remedy injustices to the nurses and I am glad the effort is being made by bringing in a measure of this kind.

There is also a system in the voluntary hospitals where nurses are asked to pay a fee of £50—I think it is more now—just to get in for training and their remuneration—I could scarcely call it wages—for the first, second and third years in these voluntary hospitals is the greatest injustice that could be inflicted on girls. That is the reason why I am appealing to the Minister to make this Bill a comprehensive one covering every nurse. I have in mind nurses employed in private nursing homes which do a big business in the line of nursing. If this Bill will not protect nurses there, it is not proper to title it a Nurses Bill. I do not wish to elaborate the point any further. Everyone will agree there has been injustice to nurses up to now and in bringing in this Bill I would expect the Minister to ask for authority from this House to deal justly with nurses in all our institutions.

I wonder if Deputy Hickey and Deputy Cowan read the Bill.

I am only taking the Minister's word.

They will find that the Bill deals with the registration of nurses and the standard of training and nothing else and deals with all nurses registered within the State.

Not their conditions of service.

No, and if the Deputy had read the Bill he would know that.

I am only asking the Minister to take power to do that.

The Minister would have to bring in a new Bill to do that.

There is no harm in suggesting it should be done.

No, but the Deputy and Deputy Cowan took advantage of this Bill to make an attack on institutions in this country where nurses are trained. That is an unjustified attack.

Is the Deputy including me in this insinuation? If that is the insinuation, I protest against it.

The Deputy may protest, but I do not think that anything disorderly has been said up to the moment.

The Bill deals purely with creating a board that will be responsible for the registration, certification, control and training of nurses and for other matters relating to nurses and the practice of nursing. Such legislation was in operation here for a great number of years. Two boards dealt with nursing. One dealt with the registration of midwives, I understand, and the other dealt with general nursing. The Minister proposes in this Bill to have one board. He is dissolving the General Nursing Council and the Central Midwives Board and creating one board to deal with both. There seems no possible objection to that and it is desirable that one nursing council should deal with all types of nursing.

Deputy McGrath raised the question whether midwives had general nursing training or not. I am not clear on that myself, but I have some recollection that they have. If they have not, I suggest to the Minister that the days of training purely in midwifery should be brought to an end and the type of nurses known as midwives in the past should be replaced by nurses who have general nursing training in addition to that as midwives. Local authorities have expressed the opinion for many years that midwifery alone is, to a certain extent, obsolete as a profession. But that cannot be dealt with in this Bill.

In so far as the Bill goes in providing for the training of nurses I see nothing objectionable in it. I suggest that the Minister might make representations to this council to sanction all county hospitals in the country as proper institutions for the training of nurses. I understand that up to quite recently very few of them were registered as suitable training institutions. I think the Minister should put all county hospitals on the list of suitable institutions for such training.

Once more, I register my objection to the comments of Deputy Cowan as to the conditions under which nurses have to work here. Conditions in other countries are held up as an example. There is too deeply rooted a habit in this House of holding up other countries as an example with regard to conditions of service in different professions. Our ambition is to have the best possible standard we can achieve for all sections of our community. Nurses are an important organisation. They are very important to the health of our people. I believe that they have at their disposal an organisation, such as other sections of the community have, capable of ensuring decent standards for themselves. The ways and means for doing that are available to every section of our community and they have legislative authority and approval. Nurses are no exception to the general rule.

The girls are not organised before they go to England.

I am talking of the conditions of service in our hospitals. I am sure the members of the House have a competent knowledge of the work done in the voluntary hospitals and the conditions of service obtaining therein. These hospitals have been attacked here. They have been accused of not giving fair conditions to their nurses. Objection is taken to the fact that nurses are required to pay fees.

I stand over everything I have said.

Deputies are not fair to the voluntary hospitals. There is nothing to prevent girls anxious to train as nurses from going to hospitals where no fees are required. Training is available in many institutions where no fee is required.

And rightly so.

If some hospitals charge fees, they give those fees back again in the way of salary during the probationary period.

£3 per month.

If that were done, the situation would be ideal.

It is done. There are long waiting lists of would-be probationers in all these hospitals. If there are not permanent posts available at the end of the period of training for all those girls who take up this particular profession that is not the fault of any particular individual or body. It is not the fault of the country or of any organisation in it if there are not sufficient posts for those who train as nurses, engineers, doctors or anything else.

Do you think it is fair to keep a girl on night duty for six or ten weeks?

I am sure the Minister is aware of the conditions of service in both the voluntary hospitals and others. He has the means at his disposal of preventing any abuses.

It is a long time without being done.

There are ways and means.

You do not want him to do it.

I want to see the best possible standard and the best possible conditions and rates of pay for all our nurses. I do not believe that the conditions mentioned by some Deputies do exist.

You are entitled to your opinion.

I was somewhat surprised at Deputy Allen just now. He tried to give the impression that everything is 100 per cent. in all our hospitals.

Nothing is perfect.

Deputy Cowan and Deputy Hickey were quite entitled to raise the question of the payment of student nurses and to ask the Minister to make recommendations to this new board in connection with conditions of service, and so forth, in relation to student nurses. I think they were only doing their duty as public representatives in emphasising the necessity for this step upon the Minister. Deputy Allen let slip—I think that is the most apposite way to describe it—a little piece of his own mind in this matter in relation to the number of girls applying for positions as student nurses. He told us that the supply actually exceeds the demand, and that there is a long waiting list of applicants. Wherever that situation occurs it leaves those in charge in the happy position of being able to dictate their own terms and conditions. If any complaint arises they are in the happy position of being able to say: "We do not want you; there are other girls waiting to get in who are quite prepared to accept the conditions that you refuse to accept." In that way all complaints are smothered.

We can congratulate our neighbours across the water on one particular aspect: by giving good conditions and good rates of pay to their nurses they have more or less forced us to follow along the same lines. I think it would have taken a considerable period to implement here a proper policy with regard to nursing conditions were it not for the fact that we have suddenly become afraid that we shall lose our best material, since those desirous of taking up this profession may be tempted by the better conditions across the water to go to England for their training.

The Minister deserves great credit for the work he has done so far in providing hospital services and so forth. I think, however, he should get down to brass tacks now in regard to the people who work in these hospitals. I believe that nurses have got a raw deal for years past. I have seen very little improvement in their conditions up to the present time. There are various points I would like to raise but I do not think they would be relevant on this particular measure. We are all agreed that we must move with the times. I think Deputy Davin pointed out that one of the things which held back development in the nursing profession and in their conditions generally was lack of organisation amongst the girls themselves.

There is a lack of organisation here at home. When I say that I mean that when girls take up the nursing profession and enter as probationers they are more like a flock of sheep than anything else. In the case of some hospitals they have many genuine grievances about the conditions, but they are afraid to tell a public representative about them or to lodge a complaint. They feel that if they were to do so they will be nailed at a later stage of their training. Whether that actually follows or not I do not know, but that is the impression these girls are under. The result is that we do not hear half the complaints from the members of the profession that we should be hearing. I have personal experience of that myself with regard to a number of hospitals. I think the Minister knows about these places too.

If an inspector is sent into any of these hospitals the girls are afraid to tell to him the grievances which they may have told to me two or three weeks earlier. The inspector comes back and makes a report to the Minister to the effect that the complaints in the hospital are exaggerated and, of course, the Minister has to go on the report of his inspectors with regard to these complaints. We have to face the facts, as Deputy Cowan said, that there is no use in treating nurses as if they were in a jail or a convent. They are grown-up people. These probationers are 18 years of age or over, and so I think they deserve a little more freedom of action than they have at the moment. I suppose there are many people here who will not agree with me in regard to that.

We have throughout the country domestic economy instructresses, poultry instructresses, typists, shorthand typists and clerks of all descriptions. Most of them are about the same age as nurses and to a great extent have received the same education. Yet the conditions under which they live are far different from the conditions under which student nurses are expected to live. I suppose there is a certain amount to be said for a little more discipline in the nursing service in view of the fact that the work nurses do is so responsible. At the same time, there is no use in treating nurses as if they were ten or 12 years of age, and of practically locking them in at 10 o'clock at night. Everything possible should be done to make them happy and contented, and not have them going across to England. There is the alternative of giving them more scope for happiness here at home, thereby encouraging them to remain at home and not go to England.

I suggest to the Minister that he should ask the council to examine the question of the staffing of hospitals. Again, I hope I will not be misinterpreted or misrepresented in regard to what I have to say on this. I think that, in the case of any hospital, it would be better to have an ordinary lay nursing service or a nursing order. I do not believe in a mixture of the two. I think it would be far better if you had a complete staff of lay nurses so that, from the time a probationer entered, the ordinary avenues of promotion would be open to her. Where you have a mixture of both, then in all cases the plum positions and the senior appointments are held by the members of the nursing order, with the result that there is dissatisfaction among the ordinary nurses. There is no opening for them to reach the positions to which they feel they are really entitled. I would ask the Minister to examine that matter. It is a rather delicate question and certain people would like to misrepresent or misinterpret what one has to say on it. I hope the Minister will give great heed to what Deputy Hickey and Deputy Cowan have said with regard to the conditions and welfare of the student body of nurses in the future.

I think it must be obvious that the manner in which this Bill has been handled by Deputies on both sides of the House has been particularly satisfying. I think that should be accepted, not so much as a tribute or an acknowledgment by Deputies on both sides of the House of the particular merits of the Bill, but rather as a tacit tribute by this House to the tremendous qualities and respect in which we all hold these ladies in the nursing profession, whether lay or religious, who are engaged in our hospitals throughout Ireland or wherever else they may be working. In the course of the debate a number of useful, interesting and helpful comments have been made. It may be possible for me to dispel some misapprehensions which appear to exist in relation to some points. Deputy Childers is interested in a number of points. He asked about the dispensary nurse which was proposed in the White Paper issued by the previous Government some years ago. The position about the dispensary nurse was that she was a sort of hybrid individual with a mixture of dual responsibilities, public health responsibility and the other. I am not certain that for the future the pattern envisaged by Deputy Childers is one that we should follow. I think, however, that the future of the nursing profession will certainly follow on the very sound lines suggested by Deputy Childers—that is, that the preventive side, in relation to public health, should be emphasised. That is to say that our nurses should receive a training which will equip them to fight conditions which bring about disease rather than wait for the actual disease to break out. I would like to assure Deputy Childers that I am in complete agreement with that approach to public health matters generally. If this board sets up the training courses which we have in mind, then the public health type of nurse, with a bias towards the prevention of disease, is a likely development in the future. At the same time, there will be the midwife, who will be related to midwifery, to antenatal and neonatal and the delivery period. In regard to ordinary infectious diseases, we shall have public health nurses. In relation to maternity work, there will be the midwife, who will have responsibility for the prevention of ill-health either in the mother or in the child by antenatal care.

Deputy McGrath and a number of other Deputies were interested in the future of the midwife and thought that she should have general nursing training in addition to her midwifery qualifications. Incidentally, I agree with that particular conception myself but I feel that it is a problem which should be left to this board, who will probably be more competent than we are to judge in these matters, to draw up the qualifications under which nurses will be allowed to practise, in relation to midwifery specifically. Deputy Briscoe dealt with a number of points but was particularly interested in the question of recruitment of probationer nurses. Deputy McGrath also displayed some interest in that matter. It is intended that this board will lay down certain minimum qualifications for trainees in the nursing service but the recruitment of the personnel will lie entirely with the heads of the boards of the different institutions, as is the practice at present. We do not believe that any material change will take place in that matter.

Deputy Childers and a number of other Deputies were interested in the position of the existing voluntary nursing organisations throughout the country. Our attitude in regard to these is that we are very grateful indeed for the contribution which these various voluntary organisations make towards our health services throughout the country. That contribution they have made throughout many long years when their services were particularly badly needed. I do not intend to interfere in any way with the services they are giving at present and am most anxious that we should be able to continue to avail of them in the future. Any further encouragement that it is in my power to give I shall certainly accord to these bodies for whom we have the greatest admiration.

In relation to the problem of staffing difficulties, and our ability to get nurses for our hospitals and institutions at present, we find, as the House is probably aware, that there is a considerably increased demand for nurses due to the expansion of services arising from institutions recently becoming available. Where the institutions are situated in large cities or towns, we have met with no real difficulty in obtaining staff. There have been isolated instances in which we have experienced some difficulty but there has not been any material disturbance in our ability to render essential services due to lack of nurses. One very gratifying development is the considerable number of nurses who tend to return to the country and who seem to be reasonably satisfied with the conditions here.

In relation to that point, many Deputies referred to the existing conditions under which many of our nurses live and in which they are trained. I am afraid I do not agree with Deputy Allen that it is in any way reprehensible for Deputies to refer to the conditions under which many of these girls in many of our hospitals, both local authority and voluntary hospitals, continue to live. I do not think the conditions are in any way as bad as they were 20 or 30 years ago. They are by no means anything like the standards which we must provide for our nurses in all our hospitals, voluntary and local authority. In admitting this fact, I know I may be held responsible for existing conditions. All I can say is that as far as I possibly can I am trying to ensure that good reasonable conditions are provided, from the disciplinary point of view, from the food point of view and from the simple point of view of comfort—single separate rooms, good kitchen facilities, etc. I am doing everything in my power to encourage local authorities to provide these minimum standards which I think our girls most richly deserve. I shall be grateful for any help which can be given in this connection by Deputies who happen to be members of local authorities and who can use their powers to help me in this task.

In relation to buildings which we are erecting at present throughout the country, I do not think the nurses' homes will be bettered anywhere in the world but that is not much good just at present. In the temporary institutions such as at Castlerea, Mallow and St. Mary's, we have tried to get standards which we think will be reasonably satisfactory. They are certainly an improvement on the conditions under which girls at present live in many of our voluntary hospitals and in some of our local authority institutions. Deputy Hickey and another Deputy were very anxious that I should take some steps in relation to the voluntary hospitals. Well, this Bill is a very limited Bill which, as Deputy Allen pointed out, is restricted to the question of recruitment, training and such like. I do not care to go into the whole problem of my policy in relation to the future of the voluntary hospitals here, but I do believe that we must intelligently anticipate the shortage which will come in from five to ten years' time, and that if we do not take steps now to deal with it the voluntary hospitals will face a shortage of nurses because of various reasons. One is that they are improving conditions considerably across the water; the second is that I am taking every step I can to improve conditions in local authority hospitals for which all of us here are responsible, and in that way I believe that I shall eventually start to drain away the long queues of nurses attending or attempting to attend the voluntary hospitals. Therefore I believe that the voluntary hospitals will be faced with a real problem to provide nurses for themselves and, consequently, I think that they should take steps to provide really good conditions where they do not exist at the moment for their nurses.

There is in Section 51 a clause which authorises this board to prescribe the manner in which and the conditions under which probationer nurses will carry out their training. I believe that this board, composed as it is largely of nurses, will take steps to see that the minimum requirements which, all of us here agree, our nurses should have will be achieved. I do agree also with Deputy McQuillan's argument that just because there may be an endless pool, as it appears there is, of nurses to train in voluntary hospitals we should then decide "why bother?" I think that we should decide the conditions which these girls deserve, provide these conditions for them and then we have discharged our responsibility. Similarly I would prefer if the voluntary hospitals had that approach to the problem rather than the one "we have plenty; why bother?"

Deputy Briscoe was concerned with the question of consultation with the medical registration council and also with the problem of the qualifications of nurses which possibly may be laid down by the board. Under Section 68 I am bound to consult with the council in respect of certain rules concerning midwifery. In relation to others concerning the qualifications of girls going into voluntary hospitals this board has representatives of the voluntary hospitals which are at present training nurses, and I feel sure that before drawing up any hard and fast rules under which these girls will be recruited and trained they will take the very obvious step of consulting the different bodies, hospitals, organisations and institutions, upon whom they are dependent later on for the proper functioning of their scheme. I do not believe, therefore, that if the board is the intelligent one envisaged Dáil Deputies need have any worries in that regard.

Deputy McQuillan mentioned a rather delicate subject to which I would like, in passing, to refer but to which I attach rather considerable importance, that is, the problem of why a lot of our girls tend to go away and reach the top without much apparent difficulty in other countries, for that is the experience of anybody who knows what happens to these girls when they do go abroad. There is a matter which local authorities must decide in each area, a matter which I know can be misrepresented in various ways but which, nevertheless, I feel is an important point in the approach of a girl to a career in nursing here at home, that is, whether she can feel that she can enter any of our hospitals and, going through the stages of probationer nurse, trained nurse, staff nurse, sister, and so on, eventually become matron of that hospital. That must be a very much more encouraging prospect to her and if she has any good in her at all I would imagine that any worthwhile girl would say to herself: "If I can get to the top in that hospital then I am prepared to go through the years of drudgery and hard work entailed in making my way up." On the other hand, if she finds that the avenues of promotion end at staff nurse or ward sister, you would find it hard to blame her if she moves to a place where there are better prospects of promotion and of administrative posts of interest. Consequently, the problem has been put to local authorities that when they are providing hospitals in the future they should consider the desirability of staffing their hospitals either exclusively with religious or exclusively with lay staff. It is a matter which rests entirely with the local authorities. Many of the Deputies of this House are members of such local authorities and if they feel that they can help in any way to improve the opportunities of our girls and encourage them to stay at home I have no doubt that they will willingly seize on such opportunities.

Deputy Allen and Deputy McGrath, I think, were concerned with the question of county hospitals becoming training hospitals. That, of course, would be a very desirable development, and I would like to see it taking place. Unfortunately, I think it is a matter which must be considered by this board, because they will have the authority to vet the different hospitals and accept or reject them as training hospitals. I believe myself—although this is not generally applicable—that if we had followed a policy in relation to our county hospitals which by a process of regionalisation—not of six or seven counties but of two or three—would have been able to provide larger hospitals, and if instead of the present type of county hospital with from 60 to 110 beds we could have 200 beds in these sub-regions, then these hospitals would have been able to provide a very much more varied staff of specialists, such as physicians, surgeons, gynaecologists, obstetricians, ear, nose and throat men, eye men, and so on. I think that that type of hospital would be very much more acceptable to the governing board of the nursing profession for purposes of training. There are some of our county hospitals which simply cannot give the comprehensive training to our nurses which it is only fair to ask that they should receive. It is a matter, however, which I hope the board will take up so that some of our county hospitals can, either by themselves or in co-operation with nearby local hospitals, regional, local authority or voluntary hospitals, give us that service, so that we can provide a wider scope for girls entering the local authority nursing service. I would be completely opposed to girls being asked for fees when going for training. That is a matter on which the voluntary hospitals have their own policy, but mine is that they should not pay fees in the local authority hospitals at any time. If a girl is qualified to go for nursing, she should be given every encouragement, and no impediment at all should be placed in her path.

With regard to the small point of discipline to which Deputy Cowan and Deputy McQuillan referred, we have responsibilities which we cannot completely ignore in the local authority services and no doubt the situation is similar in the voluntary hospitals. These girls are young girls and the officers in these institutions act in loco parentis, and I do not think that one could give the latitude suggested by Deputy McQuillan and Deputy Cowan because of the obvious dangers in relation to girls of that age. I think, however, that, once a girl becomes qualified, she has definitely come to the age when she can be trusted to look after her own best interests, and in that way I would encourage a very much more liberal attitude in the matter of recreation, discipline and the comings and goings generally of nurses. That is a matter for each local authority, and I think that on the whole they are tending to become a little more flexible in their views on this matter.

Reference was made to private nursing homes and the conditions of service in these homes. The conditions of employment and the control of these homes are matters which have given worry and concern from time to time. The girls there, if they are trained nurses, are naturally in the same category as nurses working in any other hospital or institution, and it is thereby ensured that a certain standard of nursing is available in these homes. The question of supervision, administration and so on is one which this board can, I think, usefully investigate. At present, we have no powers to deal with them, but if this board examined the conditions in these nursing homes and felt that some changes could usefully and desirably be made throughout the country, I would be prepared to introduce legislation to provide us with these powers to bring about any improvement suggested.

This is a limited Bill, covering a limited aspect of nursing generally. The whole policy with regard to the future of nursing is a matter which will require considerable thought on our part, in view of the very wide expansion which must follow the proposed mother and child health scheme, the new institutions and hospitals and the conditions of service of nurses. These are matters to which I certainly will give every consideration. I, like every other Deputy—and possibly even more so—have every reason to have the greatest respect and regard for the work done by our nurses in our institutions and hospitals, and, in formulating the policy for the future, that will be the guiding factor. So far as it is possible within the resources of the State, I shall ensure that my policy will make available for these girls the best nursing conditions we can make available, not simply lest they might become harder to get in the years to come, but simply and solely because they are deserving and more than deserving, of everything we can possibly give them.

Perhaps the Minister would allow me to ask a question. In asking it, I admit frankly that perhaps I have not made a sufficiently detailed comparison of the new board with previous boards, but I should like to know if it is necessary for the Minister to nominate so many to the board— the general board and the midwives committee. With regard to Section 12, sub-section (3), which is the section which refers to consultation by the Minister with organisations, it would be helpful to us for the Committee Stage if he would give some indication of what exactly he means by consultation. It is variously interpreted in different Acts. In some cases, the Minister accepts almost automatically 80 per cent. of the people proposed to him by the various organisations, or a number from the total number proposed to him, and perhaps adds a few individuals who, he feels, will represent his particular point of view and the point of view of the Government of the day. At the same time, he ensures that the interests of the minority within the community will have every consideration and perhaps more consideration than their numbers necessarily entitle them to. In the case of other boards, Ministers in the past have taken, if you like, a more political point of view and have rather encouraged voluntary associations to approve of their own nominations. If the Minister would tell us what his attitude is with regard to the consultation element and to what extent he thinks it necessary to nominate so many people, I think it would help us on the Committee Stage.

With regard to nominations, my policy is to accept the person put forward by the body I consult and I prefer usually to receive one name, so that the final selection rests with the body I am consulting. My only reason for proposing to nominate so many in the first instance is primarily to secure greater speed. If there were any other way of doing it, which would absolve me from the duty of nominating the first members, I should be glad to hear of it, but I do not think there is any other way.

Question put and agreed to.
Committee Stage ordered for Wednesday, 15th November.
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