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.