Dáil Éireann díospóireacht -
Wednesday, 24 May 1961

Vol. 189 No. 6

Nurses Bill, 1961—Second Stage.

Minister for Health (Mr. MacEntee)

I move that the Bill be now read a Second Time.

The Nurses Act, 1950, replaced earlier legislation dealing with the training and registration of nurses and midwives and established a new body, An Bord Altranais, to take over the functions of the former General Nursing Council and the Central Midwives Board. The object of the present Bill is merely to make some changes in the 1950 Act which time has shown to be necessary or desirable.

The Bill, made up as it is of a number of miscellaneous provisions, is essentially one to receive greater attention at the Committee Stages than at this stage. I think it will be adequate at present if I refer briefly to the provisions of the Bill and indicate the reasons why each of them has been included.

As stated in the explanatory memorandum circulated with the text, Section 2 is designed merely to clear up a doubt. When An Bord Altranais, in exercise of its powers under the 1950 Act, proceeded to draw up rules for the election of nurses to the Board, it did so on the basis of separate electorates for the different types of nurses. Thus, the draft rules provided that the midwives would elect the midwife members of the Board, the mental nurses would elect the mental nurse members and the general nurses the general nurse members, an arrangement which, I think the House will agree, was a perfectly reasonable one. The draft rules incorporating this system of separate electorates were approved by the Minister in 1953 and have operated since. However, doubts have been expressed as to whether a division of the electorate in the manner provided for in the Nurses Rules was covered by the 1950 Act. What we are doing now is to put the matter beyond doubt and so make it clear that the Nurses Rules of 1953 are in order.

Section 3 of the Bill will extend the Board's power to pay travelling expenses to its members so as to cover instances where they travel, on the Board's business, otherwise than to meetings of the Board and its Committees. Members of the Board, for instance, may have to visit hospitals which have applied for recognition as training institutions. It is, of course, proper that travelling and subsistence expenses should be payable on such occasions. The Section will remedy the oversight in the 1950 Act.

Sections 4 and 5 of the Bill are complementary.

On receipt of the audited accounts of the Board for any year, the Minister is required by Section 59 of the Act to pay over to the Board the ascertained revenue deficit for that year. Having paid over this sum, he collects back from health authorities under Section 60 half the amount. In practice, what happens is that the deficit in respect of a particular year is not recouped to the Board until twelve months after the end of that year, the Board working on overdraft in the meantime. The health authorities' share of that amount is not apportioned, collected and brought to account until the next financial year. There is, thus, a three-year cycle in respect of each year's accounts of the Board.

These arrangements, I think, are unsatisfactory in two respects—the Board has to wait for its money for over a year after the deficit has occurred and the final completion of the transaction is unnecessarily long drawn out. The existing provisions, however, are unsatisfactory in a much more important respect. They impose on the Exchequer and on health authorities an obligation to meet the deficits without giving the Minister an adequate say in the management of the Board's financial affairs.

The existing Act gives the Minister a certain measure of control in this respect. Section 61 requires the Board to submit to the Minister estimates of expenditure which may not be exceeded without his consent. Other sections require his approval to the number and remuneration of staff, the fees to be paid to examiners for their services, the travelling expenses to be paid to members and so on. All these controls, such as they are, are on the expenditure side of the account; there are no controls on the revenue side of the account.

The new procedure will provide for an annual grant to be fixed each year in consultation between the Board, the Minister and the Minister for Finance and when the grant has been fixed it will be a matter for the Board to keep its revenue accounts in balance in much the same way as the Voluntary Health Insurance Board, for instance, which gets no State grant, is required to keep its account in balance. So far as the cost to the Exchequer and to the health authorities is concerned, the new procedure will make no significant difference. This is not a device to save money for either. What will be achieved is that there will be an end to a procedure, highly objectionable in principle, under which a body created by the Oireachtas and not subject to the normal financial controls is in a position to decide for itself the size of the bill it will present, through the Minister, to the House and the local authorities for automatic payment.

Section 6 of the Bill, as explained in the explanatory memorandum, is introduced as a logical carollary of a provision in the 1950 Act. That Act made specific provision for the contingency that the Board might fail to perform any of its functions. In such an eventuality, Section 23 of the Act empowers the Minister, by order, to require the Board to perform that function. It goes further however and authorises the Minister, if the Board persisted in its failure, to remove the members from office and, further, to appoint a person or persons to discharge the functions of the Board. By a curious oversight, however, while the Act gave the Minister these rather drastic powers, it did not provide him with the means of satisfying himself whether, in fact, the Board is performing its functions. The obligation now being placed on the Board by Section 6 of the Bill to supply the Minister with information, on request, is a usual one in the case of bodies established by statute for special purposes. While I think it essential that the Board should be under a statutory obligation to furnish the Minister with such information as he requires, it is only right to say that at no time has the Board refused to give or been dilatory in giving information when required.

Section 7 of the Bill relates to the method of appointment and term of office of the President. Under the 1950 Act, the members of the Board each year elect one of themselves to act as President. The Oireachtas has by legislation created a considerable number of special bodies to which I have already referred for special purposes, industrial, commercial or, like An Bord Altranais, regulatory of a particular branch of the national life. In some cases the chairman or president is appointed by the Government or by the appropriate Minister. In other cases he is elected by the members of the body. I have been unable to trace any logical pattern in the whole procedure. I feel that, having regard to the purpose for which An Bord Altranais was established by the Oireachtas, its responsibility to the Minister for the performance of its functions and the manner in which it is financed, the appointment should be made by the Minister. I feel, too, that it is a bad principle to rotate the office of President during the five year lifetime of any particular Board and that, on the contrary, there is considerable advantage in appointing a particular person to be President each time a new Board takes office and in his continuing in office until the next Board takes over. In fact, this is what already happens under the 1950 Act in relation to the Chairmanship of the statutory Midwives Committee of the, Board. Section 33 provides that the Chairman during the entire lifetime of the Committee shall be the person appointed to the Board by the Minister under a particular head. In more recent times, the Opticians Act, 1956, and the Voluntary Health Insurance Act, 1957, provide that the President of Bord na Radharcmhastóirí and the Chairman of the Voluntary Health Insurance Board shall be appointed by the Minister for Health.

It is proposed, therefore, under Section 7 of the Bill, that future Presidents of the Board will be appointed by the Minister and that the President's term of office will normally coincide with that of the Board itself. The present President of the Board, whose term of office would normally end next January, will, by virtue of subsection (6) of the section, continue to hold the office for the term unexpired of the life of the present Board—the balance of the five-year term.

Section 8 merely removes an obligation on the part of An Bord Altranais to provide for the issue of special badges to all midwives. Most midwives are now general trained nurses who are already provided with a badge. As stated in the Explanatory Memorandum circulated with the Bill, under the new dispensation the Board, while relieved of the statutory obligation, will be in a position to provide such badges as they consider necessary for practising midwives in addition to the nurses' badge which they now issue.

Mr. T.F. O'Higgins

The Minister correctly said when introducing this Bill that it was a measure in respect of which detailed discussion might better take place at a later stage of the Bill. Certainly it would not be our intention to go into the Bill in any great detail at this stage but there are certain general observations which I think should be made. The Bill seeks to amend the Nurses Act of 1950. That Act passed through this House some eleven or twelve years ago. It was an Act which established in a regular way the education, training, and organisation of Irish nurses.

I think that generally speaking the Board that was established under the Nurses Act of 1950, An Bord Altranais, has done very excellent work over the last decade. It certainly set out to raise the standard of training for nurses and I think achieved a considerable measure of success towards attaining that object. Due to its efforts, in recent years girls going into the nursing profession now have available to them a much larger scope for training and education than otherwise they would have had.

It is important for the House to realise that over the last ten years An Bord Altranais has operated with a large measure of freedom from Departmental control and I think it was that measure of freedom which enabled the Board in its activities to achieve the measure of success it undoubtedly has achieved. It is because of that that I look with some measure of suspicion on the amendments proposed in this Bill which, whatever may be the motive for them, undoubtedly will bring the Nurses Board more under Departmental control than it has been up to this and I feel the House should have more solid reasons for suggesting a change than are contained in the Second Reading speech of the Minister.

The first major amendment, which may appear as a trivial one, is nevertheless a significant one. It is proposed in this Bill, if passed in its present form, that in future the President of An Bord Altranais will be appointed by the Minister. I do not understand the reason for this proposed change. I am well aware that the person who for many years was President of that Board was a man of independence and tremendous character and it was due to his initiative and enthusiasm that much of the success which attended the Nurses Board's activities was due. I know that the man concerned has had differences from time to time with different Ministers for Health. I have little doubt that from time to time the present Minister may have felt it desirable to have somebody else as President of An Bord Altranais.

Mr. Briscoe

He is not President.

Mr. T.F. O'Higgins

I know he is not. I am well aware that Deputy Briscoe attended one of the first meetings of An Bord Altranais for the purpose of seeing that this person did not continue as President.

Mr. Briscoe

That is not correct.

Mr. T.F. O'Higgins

But he was reelected.

Mr. Briscoe

He is not President now.

Mr. T.F. O'Higgins

I am well aware he is not President now. It is because of that suspicion that I have in relation to the person to whom I have been referring, to the fact that it certainly would have been desired some twelve months ago that he would no longer continue to be President of An Bord Altranais, that I cannot help feeling this is an amendment to meet a particular case. I cannot understand the logic behind it. Why should this House change a situation which has obtained for the last twelve years, under which An Bord Altranais itself elects his President? The Minister mentions the Opticians' Board—Bord na Radarc Mhastoiri — established under the Opticians Act. There it is true to say the Chairman or President is appointed by the Minister, but that Board had quite a definite problem to face and the Minister surely will agree that the decision for the Minister to appoint that Board was because it was obviously undesirable that any person who had a partisan view in relation to the activities of the Board should be in the Chair. Certainly when I introduced the Opticians Act to this House I had in mind, in relation to the power of appointment of the president or chairman, that a neutral person would be appointed and I am glad to note that the Minister has continued the same policy.

The Minister mentioned also the Voluntary Health Insurance Board. Again while the Chairman of the Voluntary Health Insurance Board is appointed by the Minister, it is correct also to say that the entire board is appointed by the Minister. It is not an elected board and it is not intended, nor could it be, representative of any particular profession or occupation. It is a board appointed under the terms of the Voluntary Insurance Act to carry out a particular designated purpose and it is quite different. Perhaps a fair parallel might be the National Health Council, which is a large body concerned merely with the function of advising the Minister on matters of health. The National Health Council appoints its own Chairman and I cannot see that that has worked hardship or difficulty, in any way, either for the National Health Council or for the Minister. When the National Health Council, which is the primary advisory body available to the Minister, in electing its own Chairman causes no disadvantage either to the Minister or to the Council itself, why should in the case of a much less important body, An Bord Altranais, this change be proposed? I do not like it. I feel it is an effort to extend Departmental control to a body which has worked perfectly well, a board which has been signally successful in its activities and I am certainly against it.

The next point I should like to make at this stage is in relation to another change proposed in the Bill which concerns the financial assistance given to An Bord Altranais. I can understand what the Minister has said and I can understand that difficulties will possibly arise if there is no proper means of compelling An Bord Altranais to disclose its accounts and to give the Minister all relevant information with regard to its expenditure and revenue. Obviously an omission of that kind should be cured and I agree with the Minister in that respect.

I am concerned, however, with the further step which the Minister proposes here and that is that henceforth there is going to be a definite announced grant made available by the Minister in consultation with the Minister for Finance. That means that on the Bill becoming law in each year the Minister will inform An Bord Altranais that they will have available as a grant from central funds so much in that particular year. Then Section 5 will come into operation. That provides, in effect, that henceforth the Board, knowing the amount of money it will get from the Minister will have to meet any deficit between that grant and whatever other revenue it has, and its expenditure, by the fees charged to nurses.

I think that that is imposing a very serious hardship on what is after all one of the most lowly paid professions in the country. If the policy behind An Bord Altranais is successful, there obviously should be a greater scope for education and training of Irish nurses. That possibly is going on at the moment, and it should expand. If, as a result of this change, the cost of that policy has to fall to some extent on the registration fees, it may be very difficult to carry it out as it should be carried out. I do not know of any other profession where a step of this kind has been taken. It seems quite wrong to me that girls who go into the nursing profession and who qualify should be asked to pay to some extent for the cost of nursing policy as enshrined in these Acts.

The Minister, of course, has the information; I am speaking only from very vague recollection, but I certainly cannot recollect that at any stage while I was Minister it was felt that An Bord Altranais in relation to its expenditure or the manner in which it carried out its policy was acting in any way inadvisedly or imprudently; indeed we have not heard it suggested that the call that it had to make on local authority expenditure or on State expenditure was in any way excessive. I fear now, with the introduction of the Minister for Finance into this legislation with the power to give a stated grant each year, that inevitably more and more of the expenditure of the Board carrying out nursing policy will have to be paid from the purses of the Irish nurses themselves. I think that is bad and I think it is wrong. I certainly would urge on the Minister to reconsider that proposal.

That is as much as I want to say at this stage. It follows, I think, that so far as the amendments are concerned obviously the Minister must get his Bill to the extent that the Nursing Act requires amendment, but, at a later stage, we would propose to question two of the amendments proposed in the Bill in relation to the appointment of the President and this proposed charge.

Mr. Corish

Some of the amendments proposed in this Bill are indeed welcome but it seems to me that it is another example of the reluctance of several Governments down through the years to bring in desirable amendments to an Act which they may have found wanting. Here we are 11 years afterwards and it is found that there are some defects, in some cases minor, in the Nursing Act of 1950. It surely demonstrates the reluctance to make necessary changes. It seems to me that the view has always been: "O.K., if there is a defect or a want in any particular Act of Parliament we shall wait until we have a dozen or so." We have done that in legislation down through the years. I think we should engage more in the practice of changing an Act of Parliament as we think it should be changed and immediately we believe it should be changed.

This sort of behaviour is not peculiar to the present Minister for Health. It has been the practice down through the years. It is a good thing, in any case, to take the Bill more or less as one reads it; it is a good thing to clear up the position with regard to the method of election of the various nurses on to this Board. Again, it is a position that has obtained for the last 10 or 11 years. I assume that nobody has challenged the practice whereby each section will elect its own representatives, but this does make the position much more clear.

It seems to me also that it must have been pretty difficult for An Bord Altranais to function over the past 10 years in view of the fact that they could not be paid travelling expenses for visits, as the Minister has said, to hospitals or to any other medical establishments. Up to the present, the practice has been—rather the law has been—that they could be paid only in respect of travelling expenses. I assume the Minister and his predecessor were satisfied that the Board would carry out their duties in a reasonable manner. Could I ask the Minister a question on Section 4, the section relating to the yearly grant to be made by the Government—is that a fixed grant?

Mr. MacEntee

It will be settled from year to year in discussions with the Board.

Mr. Corish

It occurred to me while asking the question that there is no amount mentioned in the Bill and if it were to be varied it would not in itself mean an amendment in the Act. I assume—and I hope I am correct— that in fixing that grant the Minister will certainly have regard to the fees that may be demanded for registration or for examination and ensure that these fees for examinations or registration will not be exorbitant.

Mr. MacEntee

That is true.

Mr. Corish

I assume that the Minister will safeguard the interests of the nursing profession in that respect because it would indeed be a very bad thing if we were to appear to tax what has been described as one of the most lowly-paid and hardest working professions in the whole country.

The only other comment I have to make is in respect of Section 7. I do not think it is a good principle for the Minister or any Minister to nominate a President of a board that has been elected by various other bodies. I am not concerned with analogies, with what happened in the Voluntary Insurance Scheme or the Opticians' Board or anything like that. I do not think it is good practice where you have say 10 or 11 sections of nurses electing their representatives to a board and different other branches of the medical profession electing or nominating their representatives, for the Minister to step in——

Mr. MacEntee

They do not nominate.

Mr. Corish

Well, elect.

Mr. MacEntee

They do not even elect. Only the nurses elect.

Mr. Corish

I do not know what system is employed to nominate the members of the Board but here we have a situation where nearly half the members of the Board are elected by various sections of the nursing profession and the Minister for Health says that this particular person is to be president. I think it is a very bad thing and that the Minister should stick to the principle whereby those who are elected, nominated or selected for membership of the Board should have the right to select their own chairman or president.

Mr. Briscoe

I was very amused listening to Deputy O'Higgins, in his opposition to sections of this Bill, to note that practically everything he uttered was a repetition of what was uttered by a certain individual—and practically by that individual only—at a board meeting held to consider this Bill. Deputy Corish has put his finger on one particular point which is of proved interest. This is a board of some 27 members. I am a member of it, but there are only 10 elected members on that board representing the nursing profession. When this Bill was being considered by the Board, I suggested if there was great suspicion about the Minister, whoever he might be, nominating the President, I would be prepared to put down an amendment to the Bill in the House to the effect that the chairman should be chosen from one of the elected members and no other and there was an outcry that doctors would not sit under the chairmanship of a nurse. I should like the Labour members to know how much attached to principle are those who are attempting to oppose the Bill because of that point.

This is a measure primarily and almost solely designed in the interests of the nurses and their profession. There are two interests concerned, the nursing profession and the medical profession. As a member of that Board I feel that, if it could not be arranged either that the nurses provide the Chairman or President of the Board or the Minister select from them, at least there should be a President who would be a neutral as between the nursing and medical professions. It is true that one member of the medical profession has, or had been, President for some 10 years and I make a present to Deputy O'Higgins of the brief he got from the gentleman who made the reference to my one sole attendance at that board which was incorrect—

Mr. T.F. O'Higgins

On a point of order, I have never been briefed by anyone in this House. I made my own speech.

Mr. Briscoe

The Deputy said he was informed by somebody that I had attended only one meeting of that board.

Mr. T.F. O'Higgins

That is so.

Mr. Briscoe

Who told him that? He was briefed to that extent and to a further extent also because, as I said before, the Deputy's speech was a repetition of the objection to that Bill made by this gentleman at a meeting of the Board.

Mr. T.F. O'Higgins

That means that two people at least share my views.

Mr. Briscoe

The Deputy may take it that I know what I am saying. I was at the receiving end for a few hours of some most insulting behaviour on the part of the gentleman concerned.

Mr. T.F. O'Higgins

There should be some limit, a Cheann Comhairle— this is a point of order—to the extent to which Deputy Briscoe or any other Deputy proceeds to tell tales out of school and to attack persons who are not members of the House. Surely there should be some limit?

An Ceann Comhairle

Nobody has been mentioned and nobody has been indicated in such a way that the person might be identified.

Mr. Briscoe

The Deputy——

An Ceann Comhairle

Would Deputy Briscoe please allow me? I am indicating that nobody has been mentioned by Deputy Briscoe in such a way as to be recognised from the statements made.

Mr. T.F. O'Higgins

He has referred to the person who was President of the Board for the last 10 years.

An Ceann Comhairle

Yes. He said that he was President of the Board for the last 10 years but he did not say he was responsible for the statement that Deputy Briscoe attended only once.

Mr. T.F. O'Higgins

As I understand Deputy Briscoe, it was quite clear to me that he was referring to the person who was President of the Board for the past 10 years.

An Ceann Comhairle

That may be clear to the Deputy but he did not indicate, or make any statement to indicate to a person not acquainted with the circumstances, who was President.

Mr. T.F. O'Higgins

That was certainly how it appeared to me.

An Ceann Comhairle

That may be.

Mr. Briscoe

The Deputy took great exception to the section which proposes to regulate the annual grant from Government funds or local authorities to this Board and he made his case on wrong grounds. Deputy Corish has the right approach to it. The position is that there is to be consultation between representatives—possibly the President—of the board, the Minister for Finance and the Minister for Health and it is quite obvious that the consultation will arise from an estimate as to the coming year's requirements. Those of us who are on the Board know that the present position in regard to finance is bad, as the Minister has pointed out, and we have had to indulge in substantial overdrafts for long periods which cost us all the more. If we can, at the beginning or shortly before or after the beginning of each year, arrange that the Minister for Health shall be furnished with an estimate of our approximate requirements and the Minister agrees to give us that grant, we will be functioning on that grant plus the estimated revenues by way of examination fees, registration fees, and so forth, and we know the approximate expenditures with regard to the holding of examinations and so on. There can be no real objection to that.

Deputy O'Higgins said that there was a danger if the grants were not reasonable. He is out of touch, if you like, with the estimated requirements. He said the deficit would have to be made up by an increase of fees. Does the Deputy not know that one of the great problems in the last ten years has been that the fees have been constantly increased and have reached a very high level and that the situation now being created will prevent that happening? I imagine that when the annual talk takes place and when things are examined the Minister will ensure that there is protection against the arbitrary raising of fees by the Board.

Mr. T.F. O'Higgins

The statutory obligation is there under Section 5. Read the Section.

Mr. Briscoe

They have risen in the last ten years, have they not?

Mr. T.F. O'Higgins

If the Deputy will look at the section he will see that it says, "The fees shall be". The obligation is on them to make sure that expenditure is met by the fees.

Mr. Briscoe

What I am saying is that the previous arrangements were bad. This will regularise the arrangements of the Board. It will be able to conduct its affairs—examinations, education, registration and placing of nurses, and so forth, and the raising of their level generally——

Mr. T.F. O'Higgins

Let us hope so.

Mr. Briscoe

——instead of having to worry as to ways and means of meeting the deficit, part of which arises from interest on bank overdraft. I see nothing in this Bill that will hurt the Board. I can see only things that will help it. I would ask Deputy O'Higgins between this and Committee Stage to think over what I have said about the present set-up of the Board. There are only ten out of twenty-seven members elected to that Board.

Mr. T.F. O'Higgins

Twenty-three.

Mr. Briscoe

Twenty-three—sorry— ten out of twenty-three. The elected members of that Board are in a minority.

Mr. Sherwin

How do the others get on to this Board?

Mr. Briscoe

They are appointed.

Mr. Sherwin

By whom?

Mr. MacEntee

By the Minister.

Mr. O'Higgins

Appointed, on nomination, by the Minister.

Mr. MacEntee

No; after consultation—that is not nomination.

Mr. T.F. O'Higgins

I know the Minister's view in relation to that. I certainly appointed them on nomination.

Mr. MacEntee

I happen to feel that I am the custodian of the rights of Dáil Eireann.

Mr. T.F. O'Higgins

What about Deputy Briscoe?

Mr. MacEntee

Of Dáil Eireann.

Mr. T.F. O'Higgins

Deputy Briscoe is on the Board, I suppose, as a representative of the county boroughs?

Mr. Briscoe

Yes.

Mr. T.F. O'Higgins

That is all right. Presumably, that is on nomination.

Mr. Briscoe

I am appointed by the Minister.

Mr. T.F. O'Higgins

I know.

Mr. Briscoe

I am trying to point out to the Deputy, who is so concerned about the welfare of the nurses, that the nurses are in a minority on that Board. They are the only elected members. It is quite clear to me that if the position is left as it is the President will always be a member of the medical profession and never a member of the nursing profession, because that is the pattern that has been worked out.

Mr. T.F. O'Higgins

What is wrong with that?

Mr. Briscoe

I feel that if the Minister sticks to this section of the Bill, gets it passed through the House and appoints the President he will appoint somebody who will be neutral as between the two interests. One must not forget that the nursing profession and the medical profession operate together right through and there are conflicts on many occasions between them and there are grievances on the part of the nursing profession against, if you like, the requirements of the medical profession, and so forth. Therefore, they who know their own profession should be in a position to be able to speak quite openly and frankly and to know that there is this neutral position and not what is inherent in the present set-up, a carry over of "the doctor and the nurse," the doctor always being the boss of the situation.

I have attended a meeting—not the first meeting, by the way—of the Board which considered this Bill in detail and I heard the various views expressed and I can say that there will not be a shock; there will not be a terrible upset, if the Bill goes through in the form in which it is now before the House.

Sir Anthony Esmonde

I am afraid I am not very enamoured of this Bill. I do not think the Minister made a very good case in favour of it. He specifically stated that An Bord Altranais was satisfactory. He also said that although he was giving himself these authorities, the Board had never failed to give him any information that he had sought from them.

Looking at it from an unbiased point of view, it does seem to me that An Bord Altranais is one of the most necessary organisations in the country. We have a particular problem here with regard to nurses in that we are unable to pay them in many cases salaries commensurate with the skill they command. We have also got to face the fact that many of our nurses are induced to emigrate because they can secure from our wealthier neighbour much better conditions. Therefore, it seems to me that when any Board is functioning well, as this Board is, one should be very slow to change it.

Deputy Briscoe got up to defend this Bill. I do not think he had read the Bill properly. I am certain he had not read the White Paper. He told us several times that there were twenty-seven members on the Board until he was corrected by two or three Deputies on this side. Secondly, he said that the nurses were in a minority on the Board. For the purpose of clarification, if for nothing else, let us have the facts. There are twenty-three members on this Board. There are ten nurses elected by the representative nurses' organisations and there are two other nurses nominated by the Minister. Ten and two make twelve. Twelve from twenty-three leaves eleven.

Mr. MacEntee

They are elected, but not by representative organisations. They are not elected by nurses' organisations.

Sir Anthony Esmonde

I am fully aware of that.

Mr. Sherwin

There are twelve nurses.

Sir Anthony Esmonde

I am discussing at the moment the statements made by Deputy Briscoe who got up here to defend the Bill as an expert who is a member of the Board and he did not know that the nurses were in a majority. I say that they are in a majority. Admittedly, they are not all elected by the nurses' organisations but they are nurses at the same time.

I cannot help feeling that the only function this Bill will serve is to clarify the position, if that is necessary, that the nurses should be elected by their own organisations. The Minister himself said, and the White Paper also indicates, that the purpose of Section 2 or one of the earlier sections is to ensure that each representative nurse will be elected by the particular organisation concerned.

Beyond that, I cannot really see that this Bill has any function. I have indicated often enough in this House my view that private enterprise and ordinary bodies, provided they are functioning properly, can do better if left to themselves, without ministerial or State control.

Mr. MacEntee

Can they do without State finance?

Sir Anthony Esmonde

No.

Mr. MacEntee

That is the point.

Sir Anthony Esmonde

They cannot do without State finance and they are not getting State finance in this Bill.

Mr. MacEntee

That is my point. He who pays the piper calls the tune.

Sir Anthony Esmonde

For eleven or twelve years this Board has functioned and for eleven or twelve years this Board has elected its own President. I do not see why there should be any change in that position. To get back to the Minister's point, if he is jealous of the rights of the State that he represents and wants to safeguard the State against——

Mr. MacEntee

I want to safeguard the taxpayer.

Sir Anthony Esmonde

To safeguard the taxpayer, if the Minister prefers it. He has a majority already. He nominates more than half the Board. Am I not right in that? There are ten elected representatives on this Board. Deputy Sherwin asked who elected the rest of them. I hasten to inform him it is the Minister who nominates every one of them. He nominates thirteen people altogether, two of whom are nurses. For that reason I cannot see why the Minister should intervene in respect of a board which has given such satisfaction as this Board has given. It is one of the most successful Boards we have in the country so far. I said at the outset they are facing considerable difficulties. They are trying to get the best conditions for people in the profession with regard to remuneration, working and living conditions particularly for those living in remote parts of Ireland. It has done excellent work. I very much regret that the Minister has seen fit to introduce that section at all whereby he should nominate the president of the organisation.

A parallel organisation, although it has quite different functions, is one of which I have the honour to be a member myself, the National Health Council. I am on that Council as a nominee of the Minister, but we always elect our own Chairman. We have elected the same chairman ever since I have been on it. He was originally put on the Council six years ago by Deputy Thomas O'Higgins when he was Minister for Health and we elected a Chairman then. On five occasions on which we have elected a Chairman we have elected the same man since. This Council serves a useful function and we carry out our work, which is purely in an advisory capacity, as efficiently as we possibly can and very much better than if we had a Chairman imposed upon us by a Ministerial decision.

The Minister referred to finance just now. This is an important board. It is a successful board which has done good work and given satisfaction to everyone. Even Deputy Briscoe admitted that in his statement a moment ago. The State should be generous in its financial assistance. A Board like this would probably cost a great deal more than, say, the National Health Council or perhaps even the Opticians' Board. It is necessary, for a Board like this if it is to function properly, to visit other places. Other places cannot be visited without expense. Deputy O'Higgins made a very fair point which perhaps the Minister had not noticed himself before—it is something to which he should give consideration—that these nurses will have to pay more if more money is to be found. That money, if it is provided by the State, will have to be found somewhere and it can only be found out of the pockets of the nurses themselves in registration fees.

I am not quite sure—perhaps the Minister will tell us when he is replying—but I think there is an annual registration fee for nurses and that means that the registration fee will have to be raised. It might be very well argued that it is for the good of the organisation. At the same time a body such as this which is doing useful work and helping to keep a profession in existence here and at full strength should not have extra charges such as that imposed on them. We hear repeatedly about the happy financial condition of the country. Ministers tell us we never had it so good and surely the few thousand pounds that are necessary out of this enormous budget which is presented to the country each year could be found for the purpose of financing An Bord Altranais.

The Minister must be aware that mental nurses are in very short supply. A mental nurse cannot be created overnight. Mental nurses must be trained if we are to deal with the mental defectives or the mental health situation with which we are faced and which is not peculiar to this country but is unfortunately a problem in every country in the world to-day. The other day at a meeting in my own constituency an expert told us that in Europe to-day there are two million people under mental treatment. If we are to deal with our problems here we must have nurses trained and I doubt very much if we can train such personnel here. It may be necessary to send nurses elsewhere to get certain kinds of training and to get it as quickly as possible so that the State or the Department of Health may meet its obligations. For that purpose I would ask the Minister to give an open ear to that question. That again brings me to the question of finance. You cannot get people properly trained here for dealing with matters like that because we lag behind other countries through no fault of our own, but you cannot send people for training without paying for it. Therefore, the Minister should take another look at the financial side of this question.

Mr. Larkin

There would appear to be some necessity for a change in the present situation in view of the fact that the Minister tells us in his opening remarks that there are some doubts as to the legality of the election of nurses to the board. If there is any doubt in this regard something has to be done to protect the situation. There is also the question of providing for the expenses of those who travel on the Board's business. If the Board is to do its job properly and if it is to organise the training and education of nurses some members will have to do something other than attend meetings. Provision is made at the moment for them to be paid expenses and subsistence allowances for attending meetings. If the Board is to function properly there are obviously other functions which will have to be engaged in and the provision for expenses where these other duties are concerned is, of course, welcome.

I am not convinced with the Minister's case for making the proposed change in relation to the appointment of the President. From what the Minister has told the House the Board has functioned well since 1950. It was a good Board. It was an active Board and there has been no complaint in relation to the manner in which it carried out its duties. If that is correct, then the Chairman during that particular period must have demonstrated his ability not only to do the job but also his willingness and his desire, as Chairman of the Board, to serve the interests of the Board and of the nurses whom the Board looks after.

There does not seem to be any particularly good reason for the Minister's desire to make a change in the method of election and in the appointment of the President or Chairman. If there is such a good reason I should be glad if the Minister would give the House the reason. The fact that the chairmen of other boards are appointed by the Minister is no justification for holding that it is the Minister who should appoint the Chairman or President of An Bord Altranais. If there have been difficulties in the past and if the method of selecting the Chairman in the past ten years has hindered the proper development of the Board, its extension and its activities, then the Minister should take the House into his confidence and tell us that.

With regard to the finances of the Board, the House appreciates the point made by the Minister that there may be difficulties under the present arrangements. Local authorities meet a considerable part of the Board's financial expenditure through the medium of making good a deficit. Whether that is a good or bad approach is open possibly to two viewpoints. If it has resulted in unnecessary extravagance or interfered with the proper functioning of the Board there is a case for a change. The proposed change is by way of grant. Section 5 provides:

Where fees referred to in section 24 of the Principal Act are chargeable, the Board shall from time to time by rules so fix their amount that, taking one year with another, the revenue from them is sufficient to meet the Board's expenditure (other than such part of that expenditure as may be determined by the Minister).

That provision could leave the Board in a somewhat invidious position. While there may be no difficulty with the present Minister for Health and the present Minister for Finance, it is possible that at some future date the Minister for Finance might decide for some particular purpose, financial stringency perhaps, to cut the grant tightly and in such circumstances there would appear to be no alternative open to the Board except to impose heavier fees on nurses.

It is not relevant to discuss the conditions of the nursing profession under this measure and I do not propose to do so, but I should like to make the comment that this is the one profession in which there is complete justification for the charging of minimum fees.

It is only fair to say that. If the Minister can assure the House that there will be definite control of and definite protection for all nurses in this regard, we could look at it in another way. The Board has the function not alone of training nurses professionally but of post-training those already successfully equipped as nurses. It is a very serious responsibility. The section provides that a grant shall be made each year. Any deficit resulting from an inadequate grant plus the inadequacy of the contribution from local authorities might quite easily place an added burden on the shoulders of nurses and, from that point of view, the section would need very careful consideration by this House.

The necessity for the introduction of this measure is to make the system of election absolutely legal. As Deputy Corish said earlier, it is strange that it should take ten years to discover that there was a drafting error in the original Bill or some mistake in the statutory provisions of and obligations under the Bill. I appeal to the Minister to do two things when he comes to reply. First of all, will he take the House into his confidence as to the need, if there is a need, for the change in the method of electing the Chairman or President? Secondly, will he assure the House, if he can, that the position of our nurses will be protected with regard to the charging of higher fees for registration and examination?

Mr. Sherwin

I agree with this Bill but I am concerned about this power the Minister proposes to take on himself of appointing a President. Up to now there was an annual election. While the Minister may make the case that it is better not to have too much rotation in the five-year period but rather to have the one person all the time, he has not made any real case for this particular appointment to come from his Department. Surely the Minister has confidence in the 13 whom he can appoint? He will appoint 13 as against ten who will be elected. Having a majority nominated by himself surely he has confidence as to whom the Board will elect as President. The present suggestion seems to me most undemocratic. It is, indeed, Fuehrer-like, and it may be resented.

I do not like this business of the Minister having the right to appoint because such a right is open to abuse. It stands to reason there will be a good deal of lobbying by people of a certain political complexion so that so-and-so will be appointed. If there were a change of Government the same practice would, of course, continue. It means that a person without certain political affiliations might never be appointed. The Minister for Justice admitted that there was patronage in the appointment of peace commissioners and even of judges. What is to prevent patronage being always a factor in the making of these appointments? Why should a person have to be of a certain kind to have a chance of appointment?

It is a bad principle that the Minister should appoint the majority, 13 as against 10. I should like to know how the Board can get rid of a chairman who is not competent. Can a majority ask for a new chairman, or can they pass a vote of no confidence? I should like to comment on the statement made by Deputy Briscoe that the medical profession would resent a nurse being present. That certainly implies snobbery on the part of the medical profession. I thought we were all alike in this world and that a worker or an egghead can be anything once he is elected by the majority. But now we are told the medical profession might object if a nurse were present. That is an insult to the nursing profession. The nurses are hardworking and are not half well enough paid. I agree with Deputy Larkin that we should be careful about the amount of fee, in view of the fact it is money they want, and more money should not be taken from them. I want to protest against this policy of appointment. Human nature is human nature, and you may bet that the person appointed is always someone of the same politics as the Minister then in office.

Mr. MacEntee

I want to emphasise one point which I think has been lost sight of throughout this debate. An Bord Altranais has been established in order to improve the standard of Irish nursing and the status of the nursing profession. That has not been done just to confer benefits upon certain individuals. It has been done in the public interest in order that the great general public, who maintain the nursing profession as well as the medical profession, should be properly served. I approach the whole question of the composition of the Board, the method of financing of the Board and the Presidency of the Board from that point of view—from the point of view of the common people of Ireland who want, if they happen to be ill, to be properly nursed and have skilled nursing attention. For that reason this Board has been given certain functions under the 1950 Act as agents of the Minister. The Act in fact provides that the Minister may remove any or all of the members of the Board; and, further, if he is satisfied that the Board is not functioning properly, he can abolish the Board or can have its functions carried out by some person or persons appointed by him.

The reason why the Minister is given that power is because, as I have said, in setting up the Board as a statutory body, Parliament had one primary objective in mind. That was to ensure that the people who have to avail of the services of the nursing profession will secure skilled and devoted—as indeed it is—attendance. As a secondary concern it was necessary, in order to attain that objective, that the standard of education for the nursing profession should be raised and that the status of nursing as a profession should similarly be exalted. It is for that reason that this Board is given certain functions in relation to the management of the examinations necessary in order to enter the nursing profession and in relation to the institution of educational curricula for the various sections of the profession. It is because this special duty has been allotted to the Board that the Dáil votes certain moneys to assist the Board in that connection.

My purpose is to put this Board in exactly the same position as every other body I know of that receives a grant from Parliament. Some of these Boards have to account in detail to the Comptroller and Auditor General for the expenditure of the moneys which are voted. Some others of them get a bloc vote and are given a great deal of freedom as to the manner in which they will expend it. But all of them except this Board, as the law stands, have to work within a figure which is predetermined before Dáil Éireann votes the money. We even apply that principle to the University Colleges. No constituent college of the National University of Ireland can come here and do what this Board is entitled to do under the existing Act.

I think it was a fatal defect in the drafting of the Act because, quite candidly, it led last year to this situation: that if the Board had persisted in its defiance of the ordinary principles governing the expenditure of Government money, I should have had to abolish the Board and appoint somebody else to carry on its functions. That is a situation which should not have been allowed to arise, but it did arise. Ultimately, however, it was possible to avoid that final sanction, but I made up my mind that such a situation was not going to arise again. Quite obviously, it would not have arisen if the same sort of financial control had been applied to the operation of this Board as applies to every other body I know of financed in the performance of a public duty by the State. As I mentioned, you have the constituent colleges of the National University. Surely it is not unreasonable to impose on An Bord Altranais the same sort of financial control which the constituent colleges accept?

Therefore, what we are asking here is that, in order that the Minister for Health, the Minister for Finance and the local authorities may know what their financial obligations are towards this Board, those obligations will be determined in advance and that we will not be coerced, as was attempted last year, into giving a blank cheque, that we will not give to the Board a blank cheque to be filled in for any amount the Board may care to fix upon. It was not that the amount was very great——

Mr. T.F. O'Higgins

What was the amount?

Mr. MacEntee

——that is not the point; it is a matter of principle.

Mr. T.F. O'Higgins

Does the Minister recollect the amount required?

Mr. MacEntee

The amount involved in the proposal would have been about £517. The point is that it is a matter of principle that this Board should be placed in exactly the same position in matters of finance as any other statutory board whose expenses in whole or in part are paid by the State. This particular Board, moreover, has a statutory duty to act as agent for the Government of the day acting through the Minister for Health. Let me say to Deputy T.F. O'Higgins that his speech was quite helpful but it is possible for us to have different views as to the manner in which the President of the Board should be appointed.

Deputy T.F. O'Higgins pointed out that the reason he had decided that the President of the Opticians' Board should be appointed by him was that he took the view a person who had partisan views should not be in the chair. I take the same view. This Board consists of persons who represent very definite sectional interests— twelve out of the twenty-three are members of the nursing profession. Others are members of the medical profession. There are only four or five laymen on the Board.

Mr. T.F. O'Higgins

There may be only two.

Mr. MacEntee

It is possible there may be only two. I take the view that the primary obligation of the Board is to raise the standard of the profession, not primarily from the point of view of its sectional interest but in order to provide a better service for the people of the country as a whole—the people who will have to avail of the services, and since it is fairly clear that both the nurses and the medical profession are liable to be subjective in their approach, my successor may find some advantage in appointing a person as President of the Board who will not be biased in favour of either the medical or nursing professions on the one hand or the other, but will be mindful of the requirements of the public at large which, after all, is a much more numerous body of people.

I think that on the whole it is very much better that the President should be appointed by the Minister. I believe for a start that it would make for far smoother working. This incident which occurred last year indicated the dangers which are inherent in the position where you have a person elected to direct the Board as its President who represents purely a professional interest. I am quite convinced that if there had been any person other than the person who happened to be in the chair when this financial issue arose the whole thing would have been smoothed out very much more rapidly than it was. As it happened it took a whole year from March the 18th, 1959, when the proposal was made to increase the fees paid to examiners. At the time that the request for increased fees for examiners was made I agreed to the request but on condition that some increase was made in the fees paid by examinees. The Board led by its then Chairman refused to accept that condition, and in consequence of that we had a correspondence going backwards and forwards for over a year.

In the end the whole thing amounted to an increase in the entrance fees for examinations of 5/-. You may say that was not a great matter but the point was you had a refusal by the Board, through its leadership, to face up to the fact that it has obligations to this House and, through the Minister for Health, to the people of the country. That was the issue which was involved and I believe that if there had been a person appointed by the Minister who could go to the Minister to consult with him and ascertain the Minister's viewpoint and who was disposed to be receptive to the Minister's arguments, that situation would not have arisen.

Mr. T.F. O'Higgins

The Minister is surely fair minded enough to imagine other circumstances as well.

Mr. MacEntee

I am in this situation: the present President of the Board has been elected by the Board. My successor will have the option of either finding a better President if he can, or, if he is satisfied with the existing President, to continue him in office. However, I think it is very important for the future relationship between the Board and the Minister that the Minister in this case should have the same power of appointment as he exercises in relation to other boards, some of which have no statutory foundation—like the Cancer Association. There is not any analogy between this Board and the National Health Council. As Deputy Esmonde pointed out, the National Health Council is an advisory body only. The only thing it can do is comment and tender observations on matters which are referred to the Council by the Minister. Therefore, the matter of appointment to the Chair of the Council does not arise in the same way.

Deputy Larkin raised the question of fees for examinations. The position there is as I pointed out to Deputy Corish earlier. The amount of grant will be determined by the Minister for Finance in consultation with the Minister for Health and An Bord Altranais, and of course this question of fees to be paid for examinations will naturally arise. It is one of the things that will certainly arise. The interest of the Minister for Health is to attract suitable candidates to the nursing profession and it may be taken as certain that no Minister for Health, by imposing unduly high charges and fees for examinations, will debar suitable candidates from the nursing profession. Deputy Larkin's idea is that it should be made easier for suitable candidates to come in. In all these cases there must be reasonable concern for the other side of the story as well— for the taxpayers and the ratepayers who foot the bill. I do not think there is any undue hardship occasioned when the fees for the examinations were increased by 5/-. I do not think, having regard to the fact that the last occasion on which the fees for the nursing examination were fixed was in 1953, that an increase of 5/- over eight years can be regarded as exorbitant.

Deputy Sherwin seemed to be under the impression that in asking the Dáil to approve of the proposal to appoint the President that I was seeking to secure the power of patronage in my own hands or in the hands of my successor.

Mr. Sherwin

You will be lobbied.

Mr. MacEntee

There is no remuneration or any form of emolument attaching to the presidency of the Board. It is a position of honour which carries some fairly onerous obligations and duties.

Mr. Sherwin

And prestige.

Mr. MacEntee

There is no power of patronage in it whatsoever and while some people might like to be appointed as President and no doubt people will be recommended for the post, nevertheless the primary consideration which the Minister for Health of the day will have in mind when he is making that appointment will be: "Is this man likely to be good enough to carry the Board and to steer the Board with discretion and wisdom?" That is what he wants. No Minister making an appointment of this sort is going to appoint any man he does not think is going to be able to carry the responsibility of the post. He does not want to be worried by complaints which will arise if the man is inefficient and therefore he will make certain that whoever he appoints will be able to conduct the affairs of the Board in a rational and intelligent way and maintain the best possible relations with the Minister for Health and his Department.

If he fails to do that of course there will be no difficulty about removing him because that is provided for under the existing Act.

Mr. T.F. O'Higgins

The trouble is the Minister can appoint only a person who is on the Board.

Mr. MacEntee

Yes.

Mr. T.F. O'Higgins

He has a very limited choice.

Mr. MacEntee

He has a very limited choice that is true but after all he can——

Mr. Larkin

He has already appointed thirteen has he not.

Mr. MacEntee

He has—it may be any of these; it may be a member of the medical profession or a layman who represents the public who pays for the lot.

Mr. Sherwin

I take it you are not going to exclude all nurses from all consideration?

Mr. MacEntee

Oh, no.

Mr. Sherwin

One gentleman said that some people would be insulted if a nurse were chairman.

Mr. MacEntee

Do not ask me to prognosticate as to what another Minister may do. I only know that this appointment will not during the lifetime of this House fall to be made by me.

Mr. T.F. O'Higgins

I wonder would the Minister tell me one thing before the question is put? Section 4 says: "A grant under this section shall be of such amount as the Minister determines in consultation with the Minister for Finance."

Mr. MacEntee

And the Board.

Mr. T.F. O'Higgins

Is that phrase "in consultation" in practice to mean "shall be such amount as shall be sanctioned by the Minister for Finance"?

Mr. MacEntee

It will be sanctioned by the Minister for Finance.

Mr. T.F. O'Higgins

The other phrase "with the sanction of the Minister for Finance" appears in some Acts.

Mr. MacEntee

It is a concession to the point of view expressed by the Board.

Mr. T.F. O'Higgins

Does it mean that under the section the Minister for Health could, having informed the Minister for Finance...

Mr. MacEntee

No. I think if you look at paragraph (b) you will see what in fact is the controlling proviso: "shall be paid out of moneys provided by the Oireachtas" and of course the Minister for Health cannot go to the Oireachtas asking for money without the sanction of the Minister for Finance.

Mr. T.F. O'Higgins

That is one of the troubles; the Minister for Finance may not share the view of the Minister for Health with regard to the proper level of nurses' fees.

Mr. MacEntee

As the Deputy is aware he is not unreasonable.

Question put and agreed to.

Committee Stage ordered for 7th June, 1961.