When Members last debated this Bill, they had reached amendment No. 7 in the name of the Minister. The Minister seeks recommital in respect of this amendment. Would the Minister of State like to proceed?
Nurses and Midwives Bill 2010: Report Stage (Resumed)
I should start by noting my appreciation of the work that has been done by various Members of the Opposition in respect of this Bill, in which there is great interest. I wish to have recommitted amendment No. 7 because as Members will be aware, it was not dealt with on Committee Stage and for something to be dealt with at a later Stage, it is normal practice to have it recommitted. As I am sure the Chair will advise, this basically means the debate will revert to Committee Stage in respect of this amendment.
Is that agreed?
No. At the outset, I seek clarification. It would be remiss of me not to again reflect on the absence of the Minister. Perhaps the Minister is a little confused. I have absolutely no objection to the Minister of State, Deputy Kathleen Lynch, taking this Bill today as both she and her colleague, the Minister of State, Deputy Shortall, are highly skilled elected representatives who are very informed on all that is taking place. However, it strikes me — and I do not mean to be humorous — that the Minister, Deputy Reilly, may simply have misunderstood what the Nurses and Midwives Bill was all about. Did he really feel that women in Labour had to take this legislation in its passage through this House? While I am sure he will answer this some day, I have no doubt this is somewhat appropriate.
I seek clarification on the seeking to recommit amendment No. 7. My amendment No. 8 stands within the approved grouping and I presume that if amendment No. 7 is recommitted, Members will deal with that in committee and then it will re-present on Report Stage, where my amendment No. 8 can then be substantively addressed. Alternatively, should I also seek the recommital of amendment No. 8 and the associated amendments the Minister has tabled that are entailed in this particular grouping? I seek clarification of the House in this regard. I am happy to accept the recommital and have clarified to my satisfaction that this is something that can be done. I can put arguments for an improvement in the Minister's position in the course of that recommital and my amendment No. 8 would then stand when Members return to Report Stage. I seek clarification that this is in order and that this is the shared understanding before Members proceed. Does the Minister of State consider this to be in order?
As I have just taken over the Chair, I ask for the Deputy's patience.
While the Leas-Cheann Comhairle goes through his briefing notes, my information is that amendment No. 8 also will be recommitted, as this is part of the same group.
The Chair will need to make a decision on the matter. In recommitting on amendment No. 8, there would be no need to revert to it, as we could deal with both amendments now if the Deputy wished and the Chair agreed.
That is fine. I made several calls yesterday and this morning to have the clarity I required before proceeding. That piece of information has not yet been proffered, so I welcome the Minister of State's comments. I am happy to have amendment No. 8 recommitted also, since it is the kernel of what I seek to have addressed in terms of improvement of what the Minister of State is proposing in amendment No. 7.
In acceding to that, I want to put the House on notice that a number of my amendments were disallowed on the basis that they might have involved a potential charge on the Exchequer, God help us all. However, amendments Nos. 20 and 21 were ruled out of order because they did not arise out of committee proceedings. I presume I must wait until we reach those amendments, but I would appreciate the same facilitation, in that, as I have established, I am entitled as an Opposition voice to seek their recommittal. I would at least like to have the goodwill of the Minister of State and the Chair in respect of the recommittal of amendments Nos. 20 and 21 when we reach that stage in our deliberations.
As the Deputy stated, we will deal with those amendments later. My notes——
Favourably.
I cannot say until we reach them, but I hope we will work together on the matter. The Minister of State must move the recommittal, on which the agreement of the House is necessary. If the question on amendment No. 7 is agreed, amendment No. 8 cannot be moved because it is an alternative. I am told this is the position.
We are discussing recommittal.
Can amendment No. 8 be recommitted and taken with amendment No. 7?
Since amendment No. 8 is an alternative to amendment No. 7, it cannot be moved if amendment No. 7 is agreed. That is my information.
Yes, but we are reverting to Committee Stage. As we are on Report Stage, I am entitled to seek to amend any amendment that is adopted on Committee Stage. If the Leas-Cheann Comhairle wishes to proceed with amendment No. 7, as recommitted, standing alone, I will put my arguments, but I will then seek to move, quite correctly on Report Stage, my amendment No. 8. Amendment No. 7 will need to be tabled again on Report Stage. The Leas-Cheann Comhairle should be under no doubt about that.
May I clarify? Since amendment No. 8 is connected directly to amendment No. 7, if the latter is passed, the former falls because it is an alternative. However, there is nothing to stop the Bill from being recommitted in respect of both. It is at that point that we will make a decision as to which of the two the House will agree. Is that clear?
I am sorry. I know this is technical, but it is important, given what is involved and how much depends on the Bill being improved. If amendment No. 7 is recommitted, my sense is that it must return to Report Stage and be moved a second time following its discussion on Committee Stage. Is that not the case? I would then be happy to seek to have amendment No. 8 accepted in the context of amendment No. 7 being represented on Report Stage. Surely Committee Stage does not supersede Report Stage. That is not the train in respect of the passing of legislation.
It is very much at the discretion of the Chair as to whether any amendment, including my own, can be recommitted.
The House must first agree on the Minister of State's proposal that the Bill be recommitted. Is that agreed?
Will the Chair indicate that it will be facilitatory towards the points I have made, namely, that we will revert to Report Stage having discussed the amendment on Committee Stage?
The clarification I have sought is that it will be recommitted to Committee Stage. However, I must repeat the fact that, if amendment No. 7 is agreed, amendment No. 8 cannot be moved. That is still the position.
On Report Stage. I accept that.
Is the question on amendment No. 7 agreed?
I agree to its recommittal.
Of course.
Bill recommitted in respect of amendments Nos. 7 and 8.
I move amendment No. 7:
In page 29, lines 38 to 40, to delete all words from and including "to" where it firstly occurs in line 38 down to and including "5" in line 40 and substitute the following:
"to provide advice to the Board in relation to all matters pertaining to midwifery practice, which the Board shall consider when performing functions in relation to midwifery practice, consisting of at least 8".
Amendment No. 8 cannot be moved because it arises out of——
No, we are not at that stage yet.
I apologise. We are still on amendment No. 7. I am just picking up on the debate.
That is okay. It is slightly confusing and very technical.
Amendment No. 7 addresses the committee concerned with midwifery. It clarifies that the committee cannot make binding decisions on the board, as the latter is overarching and has responsibility for nursing and midwifery. A committee of the board — it is not a sub-committee — cannot make decisions by which the board will be bound. There would be no point in having the board were that the case. That clarification is what we hope to achieve with our amendment. Under the amendment, the board must consider the advice provided to it by the committee in respect of all matters pertaining to midwifery practice. The amendment deals with concerns that the board would not take the advice on board. One could not have a committee making decisions that were binding on the board.
We are on Committee Stage. The Minister of State is wrong, namely, that the midwifery committee, which is to be established from Bord Altranais agus Cnáimhseachais, cannot have binding decision-making over all matters other than fitness to practice where its role and engagement with the board are concerned.
There is a need to accept that, in the passage of the Health and Social Care Professionals Act 2005, there has already been a recognition of 12 specific health professions. Why would midwifery be excluded? I remember dealing with that legislation and I do not doubt that the Minister of State and the Minister probably reflected in the same way. The Act covered such professions as occupational therapists, speech and language therapists, physiotherapists, psychologists, social workers, dieticians etc. We argued about why midwifery had not been included. I remember that particularly. I can see ongoing resistance to giving midwifery its due recognition and respect across all the disciplines in the health professions. That is very unfortunate and the issue should be grappled with. I would have argued for a separate board for midwifery if I did not believe the arguments for the establishment of a midwifery committee with similar powers were sustainable. This is a joint board relating to nursing and midwifery, two very separate disciplines and professions. It is very important that we do not perpetuate the failure to give midwifery its due respect and regard for those who practice the profession.
The Minister can improve on amendment No. 7, which has now been recommitted. I have presented real changes that will make a significant improvement to the Minister's text. It is an attempt on the part of my colleagues and me to give real powers to this midwives' committee. The powers in this legislation and with the Minister's amendment are inadequate for the profession into the future. There are very serious concerns among mothers and maternity groups, as well as midwives and their associations, over the way in which midwifery is and has been dealt with in the presentation of this Bill. Correctly, they feel that the role of midwives has not been given due recognition.
The point has been well made in the oft-quoted fact — rather than view or opinion — that the terms under which midwives are legally required to work are also the conditions under which women are obliged to give birth. If we return to the premise and accept it, there can be no doubt in our minds as to what we must do in this regard.
The Community Midwives and others point out that if section 24(3) is passed as drafted, midwifery will be the only health care profession — of which I have named a number — without the ability to govern itself. That is a major deficiency in the legislation which perpetuates the almost second-class view of those in midwifery. It is one of the oldest professions and it is highly thought of and respected by the greatest number of our populace.
The right of midwives must have equal respect to the other professions catered to under the Health and Social Care Professionals Act 2005. We must recognise that there are major crises in midwifery and the delivery of maternity care across the State. Every effort should be made to strengthen legislation to arrive at the best possible outcomes. There is currently a serious shortage of midwives running at approximately 30% in Dublin's maternity hospitals. The hospitals are down in excess of 250 midwives in the service for the city and its wider hinterland.
The KPMG report stated in 2008 that Dublin maternity services are at risk "of serious untoward incidents" as a result of the serious under-resourcing for midwifery in terms of staff employed across the three hospital sites. These hospitals cater for approximately 40% of births across the State, which is a significant responsibility. As a result of the shortage, midwives in Dublin are currently delivering nearly double the number of babies that they should be obliged to according to expert guidelines. In other words, each midwife within the system in this city is working twice as hard as he or she should be. That potentially impacts negatively on the quality of maternity care and makes medical intervention to accelerate births much more likely. Statistics bear out increases in Caesarean sections and support that view.
These front-line service providers do not want such a position to continue and midwives are the first voices and advocates for the best possible service to women before births, those in true childbirth and those needing post-natal services. I record my support for the case they put. We should make no mistake that women presenting today are less likely in overworked labour wards to be allowed to go through natural slow-birth procedures. They will almost be fast-tracked in achieving, to use an industrial term, delivery systems. That is unacceptable with all the consequences that can be involved. Normal birth numbers are clearly declining and that does not meet women's choices at this time, which must be paramount in our consideration of the matter.
The arguments for the improvement of the language are encompassed in amendment No. 8, which seeks to establish a midwifery committee "to advise the board, with binding effect other than in respect of fitness to practice matters, in relation to all matters pertaining to midwifery practice under this Act". I commend that alternative to the Minister of State and believe it to be her natural inclination. I urge her and her colleagues to assert their views on the matter and not allow a continuation of what is likely a male-dominated preparation of this legislation inherited from the previous Government.
I agree with Deputy Ó Caoláin. This legislation is very important and will define maternity services for the coming decades. Midwives are not nurses but form part of a separate profession which is in crisis. There is a belief that midwives have been seriously undermined and they have advocated a view, which I support, that they need a powerful midwives' committee. The Minister's amendment does not achieve this, and to say that midwives' opinions would be considered is meaningless. There is no obligation to take heed of the opinions or pay any attention to considerations. That is merely an obligation to listen to the midwives before proceeding.
We need a binding role for a strong midwives' committee. Many midwives are leaving the profession and it is in crisis, as Deputy Ó Caoláin noted. There is a crisis in maternity hospitals because of a severe shortage of midwives in Dublin, who are delivering a far greater number of babies than at any time before. This involves danger for staff, as well as for the women, their partners and their children. We should take heed of international experience. Modern midwifery legislation in New Zealand, Canada and so on is more reflective of the type of approach proposed in amendment No. 8 and goes against that encapsulated in No. 7. We should ensure that people have access to safer, more accessible services — which, in this era of austerity and cutbacks, can be demonstrated to be much more cost-effective and safer for the women and for their children.
Community midwifery services should be promoted. It is worrying that smaller maternity units, particularly in rural areas, are closing, which will leave thousands of women without access to proper community-based midwifery services. A key aspect in any effort to stop the rot and restore respect to one of the oldest female professions is to give this profession, as every other medical profession has, the right to govern itself. This is important and will have implications for women over the coming decades. Because of this, we should not just give a nod to the opinions of the people in this profession but should be bound by them.
There is not a parent in the country who does not have enormous respect for midwives. We need to make this clear, because they are part and parcel of one of the most intimate journeys a woman will ever take. This is something we should all accept.
Deputy Ó Caoláin has an interest and in-depth knowledge of the Bill, as I know from past experience. In this Bill, for the first time ever, midwifery is now accepted as a separate profession. We now have 100 direct-entry undergraduate midwifery places. It is not just here in the House that this profession is seen as separate; people who wish to become involved in that area of health and social care also see it as a separate profession.
We do not have a board that deals entirely with nursing or with any other health care profession. What is being proposed in this Bill is a board that will deal with nursing and midwifery, which is an advance. As a consequence, we will have a midwifery committee with a majority of midwives. A board cannot have subcommittees whose decisions are binding on the board. We all agree that cannot happen, and that is why I press the amendment. I accept everything that has been said, and I respect the philosophy that informs that opinion, but we cannot have a subcommittee that can make decisions that are binding on the board. We all know that would not work. Perhaps in the future we will need to move beyond that, but it most definitely cannot work in this type of structure.
I remember when this Bill was first mooted. My recall is that it did not include any reference to midwifery but dealt only with nursing. The Nurses and Midwives Bill was a later development. Going back to the Health and Social Care Professionals Act 2005, I always viewed — and still view — midwifery as a stand-alone profession deserving full recognition. This Bill has been awaited for a long time, and I welcome the new Government's decision to fast-track it in the first weeks of the new Dáil. We have all waited for the opportunity to get to this stage. I always hoped the midwifery committee would substitute for the need to establish a separate board for midwives. I have no doubt the Bill and the Minister's amendment fall far short of what is required. If the Bill is passed in its current form, we will have ongoing problems.
I have already made a point about the growing number of Caesarean sections in various hospitals. The 2008 KPMG report mentions that 28% of all live births in the Rotunda Hospital in 2008 were by Caesarean section, and I am told that is just marginally above the State average. We are talking about at least a quarter of all births across the State. This is not what women would opt for first, and if the child had a voice, it might not be his or her choice either. Such a level of intervention has implications for sustainability as well as patient safety.
There is also the further consideration, in a time of serious economic constraint, that a Caesarean section costs three times more than a normal birth. The Government is exercised about every possible saving, but by not conferring binding responsibility on the midwifery sub-committee it will allow the perpetuation of practices that are costing every contributing taxpayer more than they should. Partly on cost grounds, the KPMG report also emphasised the need for significant enhancement of primary and community care. Moving care out of hospital and into the community is key to the HSE's alleged transformation programme, although I have mixed experiences of that in my constituency and region. Such changes, where they are happening, will require midwives to develop autonomous practices. This is another reason for a midwifery committee that will act on behalf of midwives in a knowledgeable and decisive way, not only by giving recommendations and advice for others to decide on but by overruling, setting aside or introducing measures.
If we consider international experience, we will see that modern midwifery legislation has empowered midwives in a variety of settings. The examples I cite are Canada, New Zealand, France and the neighbouring island of Britain. To amend subsection (3) as I propose would help to address the situation. Again I urge the Minister of State not only to accept the arguments of binding effect but also to accept that amendment No. 7 seeks only to increase to eight the draft legislation's recommendation of at least five members. I take some encouragement from the fact we are using terms like "at least". In amendment No. 8 I ask for at least ten. I sought to achieve that number in amendment No. 9 but it was knocked on the head because if another couple were put in, God forbid the expenses that might be involved. The State surely could not carry this number and we are all far too busy bailing out the banks with billions of euro. God forbid we should have another midwife coming along to decide how the profession's outlook for the future might be improved.
I ask again that that element also be addressed but if it comes to a situation where the figure stands at eight, at least, I hope the Minister of State will use her influence to ensure the Minister for Health and Children, Deputy James Reilly, is as generous and facilitative in ensuring the greatest possible representation. That was the reason for many of my amendments.
I understand the Minister of State is to press the amendment. Does she wish to say anything further?
I will be brief because we have other matters to cover. If a recommendation were to come from the midwives' committee I do not believe the board proper would set it aside or ignore it. It will probably be more for the future but we hope to appoint people to boards who at least have a knowledge of the area and would therefore recognise that when a recommendation comes it would be both sensible and appropriate. I wish to reassure people on that score.
I declare the amendment carried.
It is not. I challenge that decision. It is normal for the Chair to indicate a belief the amendment has been carried rather than to declare it carried. I disagree with the Chair's belief and wish to call a vote.
Amendment put.
The Committee divided: Tá, 86; Níl, 32.
Tá
- Bannon, James.
- Barry, Tom.
- Broughan, Thomas P.
- Burton, Joan.
- Butler, Ray.
- Buttimer, Jerry.
- Byrne, Catherine.
- Byrne, Eric.
- Cannon, Ciarán.
- Carey, Joe.
- Coffey, Paudie.
- Conaghan, Michael.
- Conlan, Seán.
- Connaughton, Paul J.
- Conway, Ciara.
- Coonan, Noel.
- Corcoran Kennedy, Marcella.
- Creed, Michael.
- Daly, Jim.
- Deenihan, Jimmy.
- Deering, Pat.
- Doherty, Regina.
- Dowds, Robert.
- Doyle, Andrew.
- Durkan, Bernard J.
- English, Damien.
- Farrell, Alan.
- Ferris, Anne.
- Fitzgerald, Frances.
- Fitzpatrick, Peter.
- Flanagan, Charles.
- Flanagan, Terence.
- Gilmore, Eamon.
- Hannigan, Dominic.
- Harrington, Noel.
- Harris, Simon.
- Heydon, Martin.
- Howlin, Brendan.
- Humphreys, Heather.
- Humphreys, Kevin.
- Keating, Derek.
- Keaveney, Colm.
- Kehoe, Paul.
- Kelly, Alan.
- Kenny, Seán.
- Kyne, Seán.
- Lawlor, Anthony.
- Lynch, Kathleen.
- Lyons, John.
- McCarthy, Michael.
- McEntee, Shane.
- McFadden, Nicky.
- McGinley, Dinny.
- McHugh, Joe.
- McNamara, Michael.
- Maloney, Eamonn.
- Mathews, Peter.
- Mitchell O’Connor, Mary.
- Mulherin, Michelle.
- Murphy, Dara.
- Murphy, Eoghan.
- Nash, Gerald.
- Naughten, Denis.
- Neville, Dan.
- Nolan, Derek.
- Noonan, Michael.
- Ó Ríordáin, Aodhán.
- O’Donnell, Kieran.
- O’Donovan, Patrick.
- O’Dowd, Fergus.
- O’Reilly, Joe.
- O’Sullivan, Jan.
- Penrose, Willie.
- Quinn, Ruairí.
- Rabbitte, Pat.
- Reilly, James.
- Ring, Michael.
- Ryan, Brendan.
- Shatter, Alan.
- Sherlock, Sean.
- Stagg, Emmet.
- Timmins, Billy.
- Tuffy, Joanna.
- Twomey, Liam.
- Walsh, Brian.
- White, Alex.
Níl
- Boyd Barrett, Richard.
- Collins, Joan.
- Colreavy, Michael.
- Crowe, Seán.
- Daly, Clare.
- Doherty, Pearse.
- Donnelly, Stephen.
- Ellis, Dessie.
- Ferris, Martin.
- Flanagan, Luke ‘Ming’.
- Fleming, Tom.
- Healy, Seamus.
- Higgins, Joe.
- Kirk, Seamus.
- Kitt, Michael P.
- Lenihan, Brian.
- Mac Lochlainn, Pádraig.
- McConalogue, Charlie.
- McDonald, Mary Lou.
- McGrath, Finian.
- McGrath, Mattie.
- McLellan, Sandra.
- Ó Caoláin, Caoimhghín.
- Ó Cuív, Éamon.
- Ó Fearghaíl, Seán.
- Ó Snodaigh, Aengus.
- O’Brien, Jonathan.
- O’Sullivan, Maureen.
- Ross, Shane.
- Smith, Brendan.
- Stanley, Brian.
- Troy, Robert.
Tellers: Tá, Deputies Emmet Stagg and Paul Kehoe; Níl, Deputies Aengus Ó Snodaigh and Seán Ó Fearghaíl.
Amendment declared carried.
Bill reported with amendment.
Amendment No. 8 cannot be moved as we have passed amendment No. 7.
Amendment No. 8 not moved.
We were in committee dealing with amendment No. 7. To give some comfort, I do not intend to call a division but is it not the case that we are now back on Report Stage and amendments from Committee Stage must be presented again on Report Stage? I wish to check procedure and it is my understanding that is correct.
As the wording in the Bill has been changed, amendment No. 7 has been decided.
On Committee Stage?
Yes, that has been decided on.
Does that eliminate the need for it to be presented again on Report Stage?
It is an alternative to the Deputy's amendment so we must go on to the next amendment.
My point is not being understood. I will not labour this but we have just recommitted amendment No. 7 to Committee Stage. We have dealt with it and it has been passed. I presume we are now back on Report Stage. Would amendment No. 7, passed on Committee Stage, now be presented again on Report Stage?
We cannot have a separate Report Stage.
I just wanted to establish the factual position.
Amendment No. 9 not moved.
I move amendment No. 10:
In page 29, line 42, to delete "a registered midwife who is a" and substitute the following: "two registered midwives, each of whom is a".
This relates to the numbers on the midwives committee. I hope that while there is not an increase to ten, the increase is still significant and I hope Deputy Ó Caoláin can agree to it.
Can I speak to this?
It has already been discussed.
It has been discussed when, may I ask?
It was discussed with amendment No. 7, when amendments Nos. 7, 8, 10, 16 and 17 were taken together by agreement.
I would have indicated that I would have withdrawn amendment No. 11 and accepted amendment No. 10.
Amendment agreed to.
Amendment No. 11 not moved.
I move amendment No. 12:
In page 29, line 43, to delete "at least 4 other" and substitute "at least 6 other".
It is agreed but I ask that the extended numbers be considered.
Amendment agreed to.
Amendment No. 13 not moved.
Amendment No. 14 has been ruled out of order as it involves a potential charge on the Exchequer.
I accept that ruling but there were two elements to amendment No. 14 and by looking back now, I think I should have broken it up.
In amendment No. 14, I sought four midwives to be provided for in that subsection. I then continued "including one who shall be a self-employed community midwife". That latter point is lost on the basis of the numbers at the outset of my amendment. I do not wish to press it, but I ask the Minister of State to take on board that section 24(3)(b)(i) at the top of page 30 states “2 midwives, including one who may be a self-employed community midwife;”. I ask the Minister of State to reflect that the word “may” allows for it not to happen. I ask that be changed to “shall be a self-employed community midwife;”. I believe self-employed community midwives must be statutorily provided for in terms of access to the structures post this legislation.
I will ask the Minister of State to reflect on that but the amendment is out of order.
It may be out of order but the Deputy's point is valid and I will reflect upon it.
Amendments Nos. 14 and 15 not moved.
I move amendment No. 16:
In page 30, between lines 6 and 7, to insert the following:
"(iii) a registered nurse who is a member of the Board;".
Amendment agreed to.
I move amendment No. 17:
In page 30, lines 7 and 8, to delete all words from and including "(iii) a" in line 7 down to and including "not" in line 8 and substitute the following:
"(iii) two persons, each of whom, in the opinion of the Board, is representative of the public interest and each of whom is not".
Amendment agreed to.
Amendment No. 18 not moved.
I move amendment No. 19:
In page 30, to delete lines 47 to 49 and substitute the following:
"(11) Subject to subsections (9) and (10)—
(a) there shall be at least one nurse and one midwife on each of the Preliminary Proceedings Committee and the Fitness to Practice Committee, and
(b) at least one third of the membership of each of the Preliminary Proceedings Committee and the Fitness to Practise Committee shall consist of persons who are either registered nurses or registered midwives.”.
Where it provides for "at least one nurse and one midwife", I presume the "at least" applies to both at least one nurse and at least one midwife on each of the preliminary proceedings committee and the fitness to practise committee. With that clarification of the wording of the amendment, I am happy to support it.
Amendment agreed to.
Bill recommitted in respect of amendments Nos. 20 and 21.
I move amendment No. 20:
In page 31, line 30, to delete "or the Fitness to Practise Committee" and substitute the following:
", the Fitness to Practise Committee or the Midwives Committee".
Both of these amendments were ruled out of order on the basis that they did not arise out of committee proceedings and I am now asking the support of the House and the Ceann Comhairle to briefly allow their recommittal so we can address them. I assure the House that it will not take much time.
Section 24(15) of the Bill states: "The acts of a committee (except the Preliminary Proceedings Committee or the Fitness to Practise Committee) shall be subject to confirmation by the Board unless the Board dispenses with the necessity for such confirmation." Section 24(17) states: "The Board may dissolve a committee other than the Preliminary Proceedings Committee or the Fitness to Practise Committee." Amendments Nos. 20 and 21 can be judged separately; they are not grouped. I seek to include the midwives committee in the wording in each section. Subsection (15) would then state: "The acts of a committee (except the Preliminary Proceedings Committee, the Fitness to Practise Committee or the Midwives Committee) shall be subject to confirmation by the Board unless the Board dispenses with the necessity for such confirmation." Subsection (17) would further state: "The Board may dissolve a committee other than the Preliminary Proceedings Committee, the Fitness to Practise Committee or the Midwives Committee."
It is important for the work of the midwives committee that it enjoys the assurance that its work and integrity are respected by the board at all times. It should be the case that the board should not be able to dissolve the committee, just as the preliminary proceedings committee and the fitness to practise committee are enshrined. That should also apply in subsection (15) to acts of the committee being subject to confirmation by the board. That is surely not at variance with the Minister of State's already stated position in arguing for amendment No. 7. I would like to see the midwives committee included there and in subsection (17) to protect the committee's position. I urge the acceptance of amendments Nos. 20 and 21.
We are back to the argument with regard to whether there should be a governing board. If there is such a board, then it cannot be the case that a committee or sub-committee thereof be allowed to make binding decisions. I fully accept that midwives will make the argument that theirs is a separate profession and for the first time ever this is recognised in the Bill. They will also argue that they should have the right to govern their own profession. However, that is not the structure with which we are dealing in the Bill before the House. As already stated, we may perhaps move past the structure to which I refer in the future. As of now, however, we are not in a position do so. A governing board could not operate if one of its committees or sub-committees could make binding decisions which would tie that board into adopting positions with which it might not agree.
In the context of being able to dissolve a committee, the Deputy and I are here long enough to recognise the fact that it is possible to have extraordinarily good boards and extraordinarily sloppy ones. In the event that the board is not doing the job with which it is charged — and the Deputy and I may disagree on the nature of what will be expected of it — the Minister must have the power to dissolve it. If we had that power in other areas, we might be able to move much more quickly to deal with particular matters. What is outlined in the Bill provides a built-in safeguard that will protect everyone, including the board and the sub-committee in question.
I cannot accept amendments Nos. 20 and 21 for very practical reasons. At the heart of those reasons is the fact that we are obliged to deal with the legislation before us. As I have stated on a number of occasions, in the future we may move past this provision. We will not move past all of the Bill because the remainder of it is quite good. Given the fact that we must deal with the Bill as it stands, I cannot accept the amendments. However, I fully accept what the Deputy is saying.
The Bill states that: "The acts of a committee . . . shall be subject to confirmation by the Board." There are two exceptions in this regard, namely the preliminary proceedings committee and the fitness to practise committee. I am of the view that the midwifery committee should also be an exception in this regard. I do not know whether she intended to frame matters as she did but the Minister of State is correct that it is possible to have bad boards. I agree with her. I am seeking to protect the midwifery committee because there could be bad boards.
I do not want a situation to develop whereby the midwifery committee could be dissolved at the drop of a hat in circumstances where its continued existence might not suit the greater number of and wider interests involved with the board. The representatives of the midwives will only have the certainty of their position, namely, through engaging at their committee with the representatives of nurses and other health professionals. They must also have certainty with regard to what they can achieve there. The board may certainly dissolve a committee but there are two exceptions in this regard, namely, the preliminary proceedings committee and the fitness to practise committee. I am of the view that the midwifery committee should also be an exception.
All of this is linked to our earlier debate on amendment No. 7 and is part of the out-working relating thereto. The only solace I can take from what the Minister of State indicated — I do so sincerely — is that while this is the situation with which we are now dealing in the context of the passage of amendment No. 7, perhaps the political will, will be present in the future to address this matter in a more appropriate manner.
Due to the fact that all of these amendments are linked and as a result of the fact that we have had a fairly wide-ranging discussion in respect of them. I am not sure whether there is very much more to be said. I accept the sincerity of all parties involved but I cannot accept amendments Nos. 20 and 21.
I will be pressing both amendments to a voice vote. I will not repeat what we have just been through in respect of amendment No. 7 because there is no purpose in doing so.
Question, "That the words proposed to be deleted stand.", put and declared carried.
Amendment declared lost.
I move amendment No. 21:
In page 31, line 37, to delete "or the Fitness to Practise Committee" and substitute the following:
", the Fitness to Practise Committee or the Midwives Committee".
Question, "That the words proposed to be deleted stand.", put and declared carried.
Amendment declared lost.
Bill reported without amendment.
Bill recommitted in respect of amendment No. 22.
I move amendment No. 22:
In page 31, between lines 44 and 45, to insert the following:
"(19) Where the Board establishes a subcommittee of any committee established under this section, that subcommittee may perform any of the functions of the committee concerned as if it were that committee, and every reference in this Act to that committee shall, unless the context otherwise requires, be construed as including a reference to that subcommittee.".
This is a defining amendment and is designed to ensure that the board functions properly. Under it, a sub-committee or any committee may perform any of the functions of a particular committee. In other words, a sub-committee of the fitness to practise committee can perform the functions of that committee. The amendment merely determines different functions.
This is a standard amendment and I have no objection to it.
Amendment agreed to.
Bill reported with amendment.
I move amendment No. 23:
In page 37, to delete lines 1 to 6 and substitute the following:
33.—Section 32 shall, with all necessary modifications, apply to an employee of the Board who becomes a member of the European Parliament as that section applies to an employee who becomes a member of either House of the Oireachtas.
This amendment is designed to allow employees of the board to stand for election and thereby exercise their democratic rights. On Committee Stage we dealt with the provision which prohibits an employee from being a member of a local authority. There is a great deal of merit in allowing employees to be members of local authorities. Given that public sector employees can make a valuable contribution to local government, I am proposing amendment No. 23, which will allow employees of the board to be members of local authorities. I ask Deputies to support the amendment, which is reasonable.
I have no objection. I expect that many of those involved would be people I would be happy to support.
Amendment agreed to.
Amendments Nos. 24 and 29 are related and will be discussed together.
I move amendment No. 24:
In page 38, lines 39 and 40, to delete "or a post".
On Committee Stage, the provisions relating to advance nurse and midwife practitioner posts were removed. Following their removal, a number of corrections are required. Amendment No. 24 removes the reference to "post" in section 38, which relates to the fees the board may charge, and amendment No. 29 removes the reference to "post" in section 53, which relates to correction of the registers. Again, these are technical amendments.
Amendment agreed to.
I move amendment No. 25:
In page 39, lines 24 and 25, to delete all words from and including "who" in line 24 down to and including "rules" in line 25.
We had detailed exchanges yesterday and this morning, but I regard this as one of the most important amendments before the House. Section 40 states that "no person shall, for reward, attend a woman in childbirth unless the person is (a) a registered midwife”. I wish to delete the words after that. They are, “who maintains adequate clinical indemnity insurance in accordance with the rules”. Paragraph (b) refers to registered medical practitioners, but I do not note anything stating that a medical practitioner must maintain adequate clinical indemnity insurance in accordance with the rules. This is a further indication of the almost two-tier attitude towards health professionals in some disciplines and midwives, most particularly, in the context of this Bill. The amendment is an important one. This section could severely curtail the ability of women to access midwife-led childbirth.
I have consulted widely with a number of midwives and midwives' representative groups. They have provided me with a range of important information. I have no doubt midwives wish their opinions to be reflected strongly at this time. We want to ensure that childbirth is safe and that all those providing care and assistance for women in childbirth are properly qualified, registered and accountable. That is an absolute essential. Let there be no doubt about that.
We also accept that indemnity is necessary. However, I argue that it should not be made a statutory requirement, as is provided for in the Bill. The better alternative is to make indemnity a requirement in service-level agreements, such as the current memorandum of understanding governing services provided by self-employed midwives.
Section 40(1), as drafted, paves the way for criminalising autonomous midwifery practice by setting terms of imprisonment. It is horrific to look at what is prescribed here. Terms of imprisonment of up to ten years are prescribed for midwives who assist in given birth situations and who break the extremely restrictive rules that underpin indemnity. It has been noted that doctors, for whom insurance is not legally compellable — something the House may not know — face no such threatened penalties. Nor is there any provision for other registered medical practitioners in the drafting of this legislation. Making midwifery indemnity a statutory requirement does not serve the public interest.
Section 40(1), as drafted, would enable the insurer, in this instance the State, to dictate the terms and conditions of childbirth for maternity service users. In other words, this tells women the limited options they may have and the circumstances that must apply. How far does the nanny state have to go? This intrusiveness in the rights of women is quite ridiculous. It is because of what has been described by the Community Midwives Association as "the minute and inflexible conditions attaching to this insurance". It is unobtainable, for instance, if a mother turns 40. We had echoes of that in the outrageous practices and the denial of compensation when horrendous acts were carried out against women by an obstetrician and gynaecologist in my region. The former Minister for Health and Children, under advice from outside this institution, decided that women over 40 who suffered those outrageous acts were not entitled to compensation. What is it about women at 40? I am sure when I go home I will be put out of the house for saying what I am about to say. My wife and I were very happy to be parents of a child after both our 40th birthdays, and it was not just the next year either. I do not understand the notion that issues arise when women hit 40. There are none. It is a woman's right to decide and her health that will determine her decisions on any matter that may present.
This measure is very poorly thought out, or else it is something else entirely and is quite purposely being pursued to effect certain control, not only of midwives but of women's choices as to how and in what circumstances they wish to give birth. That is not on.
Section 40(1), as drafted, restricts self-employed midwives from accepting various categories of mothers as clients. It further obliges self-employed midwives to abandon their clients in mid-labour — think about it — should they exhibit some change in their condition that is prohibited by the terms and conditions of the midwife's indemnity. A midwife could be attending a woman when a circumstance might present that, under the indemnity, excluded her from continuing to give hands-on care at the risk of ten years in prison. This is bizarre.
Making indemnity a statutory requirement threatens women's safety in childbirth. Section 40(1), as drafted, leaves a mother whose midwife's insurance has just lapsed with two alternatives. She may give birth at home without professional attendance or face unwanted medical treatment in hospital. Women who do not fit the indemnity criteria are already opting to give birth at home without professional attendance. That fact is easily established.
Section 40(1), as drafted, prohibits attendance by uninsured midwives, even in cases of sudden or urgent necessity. If a midwife whose indemnity had lapsed, in a social situation or going about her normal business, were to come upon a woman who found herself in sudden or urgent need, she would not be able to assist. She would run the risk of a massive fine or a term of imprisonment. The rest of us could rush to give assistance but the midwife, perhaps the only person in the company who had the necessary skills and knowledge, could not. This is absolutely outrageous.
At a time when many of the country's maternity units are threatened with closure, prohibiting emergency care by, for example, retired midwives does not make sense. Reference to the 2010 Royal College of Physicians in Ireland/Health Service Executive report on acute medicine will confirm this. Section 40(1), as drafted, significantly narrows the terms and conditions under which midwifery can be practised. The existing memorandum of understanding is anti-competitive in that it significantly restricts the client base of self-employed midwives and this, in turn, significantly restricts women's access to the services of such midwives. Self-employed midwives are and seek to be, insured. We are not arguing here for anyone not to be indemnified. The community midwives state and others in the sector agree, that safeguarding mothers against uninsured practitioners is easily achieved within a birth community that is relatively small and tightly knit.
Section 40, as drafted, would effectively deny women choice in maternity care. This is not in the public interest. Hospital maternity services are at risk all over Ireland. Plans are advanced to close many of the country's maternity units, as I know only too well in my county and community. Community services must be developed to take the place of these services and the Bill as it stands restricts this possibility.
Women not living in urban areas across rural Ireland have needs in childbirth that must be addressed. Some face journeys of two hours in labour to access inpatient care, such journeys often ending with a medical induction or a so-called, elective Caesarian. By effectively stifling midwives' right to offer services in the community, section 40 denies women the right to access community care from midwives. Self-employed midwives have been unable to access insurance on the private market in recent years. This is the situation today. The only indemnity currently available to them comes from the State and this is based on what can only be described as narrow HSE home birth services.
Section 40, as drafted, prevents midwives from providing all kinds of services in the community such as post-natal care and in Ireland the levels of post-natal care are among the lowest in Europe. The section, unless amended, will deny large numbers of women the freedom to give birth at home. It could lead to a rise in the number of unattended births. Mothers who do not fit the State's terms and conditions are already opting to give birth at home unattended. No mother should have to give birth at home without professional assistance. Section 40, as drafted, locks in an insurance package based on a HSE contract that ensures that indemnity can lapse from moment to moment depending on the progress of a woman's labour.
My amendment No. 25 is designed to reduce the risk posed by the current arrangements. These HSE terms and conditions are operated in such a way as to prevent midwives from exercising their clinical judgment and even from exercising their duty of care to mothers and babies. Self-employed midwives who feel ethically bound to continue to assist a home birth mother whose labour does not conform to insurance rules, for example, now face jail under this Bill. This is a recipe for unsafe care. Just in case the ten years' imprisonment did not shock Members, a significant fine can be applied to midwives who are outside of the terms of the HSE position. I do not have the figure to hand but it is noted in my notes.
Awards against midwives in the community are few and far between. Over the past 30 years, payouts in respect of self-employed midwives have come to less than €250,000 in total. This can be compared to other health professionals. I cited one instance earlier in my contribution with regard to an alternative to the midwife, an obstetrician gynaecologist who cost the State millions of euro in compensation. That was one consultant in a particular place and, sadly, there are many other examples. By criminalising midwives who practice outside the State's onerous terms and conditions, section 40 denies women the right to opt for a physiological service, one that is low-tech and drug-free. This is a right that has been recognised by the European Court of Human Rights. Section 40 even prevents midwives from offering services such as breast-feeding advice in the community, cutting women off from their services. The breast-feeding rates among community midwives' clients are among the highest in the European Union while national rates are among the lowest.
While midwifery-based care leads to better health outcomes for mother and baby and greater client satisfaction, it also reduces costs. Making midwives the main care-givers in the majority of births would save millions of euros. Data from the Netherlands show that while one woman in every four had a home birth, home births made up only 5% of the total cost of care. Here in Ireland a bed in one of the big teaching hospitals costs in the order of €1,000 a day. Therefore, a 10% home birth rate would result in savings which are difficult to calculate but would be in the range of between €7 million and €14 million annually, depending on the numbers born. This is without factoring in the cost of unnecessary Caesarean sections which I have already referred to in an earlier amendment. The Bill, as drafted, cuts off this possibility and I strongly urge the Minister of State to accept the bona fides of the argument, the absolute need to regard the registered midwife as a responsible professional who seeks to ensure the best possible care and attention for her client, the woman in labour. The addition of the statutory requirement for indemnity insurance is unnecessary. That it is quite purposely singles out midwives and ignores all of the other so-called medical practitioners, is insulting to the midwife profession as a whole.
There is not much scope for any new points after Deputy Ó Caoláin's contribution. I support the amendment. The key point is if the scenarios outlined by Deputy Ó Caoláin are true and I believe them to be true, then we have to take serious regard of this amendment. It is a very practical amendment and it will not do anybody any harm. There could be no reason not to support it and the only outcome is a positive one for women and their children, for the midwives and for society as a whole. Maternity services here are in crisis and nobody could argue otherwise. This situation has an impact on the safety of women and children and an impact on the professions. We have a responsibility to tease out the best solution to that problem in the interests of everybody. Best international practice supports a very proactive approach to community-based care provided by midwives for all of the reasons suggested. It is more cost-effective and is better all around.
The points made by other speakers need to be re-emphasised. The method of giving birth has been established as a choice for women, a right to choose the circumstances in which they give birth to their children. In passing this legislation, considering all of the problems highlighted by Deputy Ó Caoláin, we are denying that right and undermining it. We are conflicting with the rights already established by Europe. The point has been well made that if this amendment is not passed, the Bill could succeed in criminalising people who are trying to do their job and who are trying to use their professional expertise. This would be a crazy policy. Mandatory insurance has to be dropped. It belongs in service contracts and any concerns can be well addressed in that regard but to include it in this section is to discriminate against midwives. It diminishes the profession and will have a seriously negative impact on the community, particularly in rural areas. It is exceptionally serious. I do not see any reason this amendment cannot be accepted.
Before I respond to the points that have been made, I wish to inform the House that the Minister, Deputy Reilly, intends to amend the Medical Practitioners Acts to ensure all medical practitioners will have indemnity insurance. That is long overdue. I take Deputy Ó Caoláin's point about general practitioners, gynaecologists and other health professionals not being required to have insurance. The Minister's proposal will introduce such a requirement.
I believe being pregnant and having a baby is not a medical condition. I hope as many women of a particular age as possible can meet with the joyous experience of this natural condition. We need to make it clear that it is not something to be terrified of. Although I do not believe our maternity services are in crisis, having had some interaction with them recently I accept they may be a little overstretched. That can happen when there is an influx of people having babies at a particular time, for example. It is dangerous to use the word "crisis", especially when one is talking about people who are vulnerable as they prepare to have babies. I do not think we should encourage women to panic. I believe in telling them the truth, but not in causing them to panic.
Deputy Ó Caoláin and I have a great deal in common in our attitudes to this country's maternity services. We need to ensure our community midwives are insured. That is something we absolutely must have. We have been very fortunate up to now, but all it takes is one incident for things to change. When one considers the calibre of the people who are offering women the choices they want, one has to accept that luck plays no part in it. I have always said that life is about choices. It is equally important to have a number of choices and to be informed about those choices. I do not think it is fair to midwives or those they serve to allow them to work without being insured. Midwives are very well trained. They are intuitive people. Most women would tell one that they would prefer a midwife to a gynaecologist any day of the week. The intuition and ease with which midwives approach childbirth is very important to women who are in labour.
We need to get some things straight. This indemnity does not prohibit midwives from providing post-natal or antenatal care. It is clearly and strictly about the birth. We all know things can happen before or after the birth. The high point of this process is the birth itself. That is what this piece of insurance is about and that is what we should concentrate on. It is a question of patient safety. We all know people who offer valid and worthwhile services to women who would prefer to have their babies at home. We need to ensure such people are insured. It is not a matter of prohibition — it is about insurance and ensuring the health and safety of the mother and the baby. It is hugely important that community midwives who have signed service level agreements can connect into the local maternity service and have that as a back-up if something starts to go wrong. These things can happen. That support is important for the safety and security of the person being served by the midwife and it is equally important for the midwife. I can only imagine the trauma experienced by the midwife and the mother who is delivering when something begins to go wrong.
We need to ensure we cover all the bases. We should move beyond particular interests. I agree with virtually everything the midwives say. One woman told me a gynaecologist told her she was early, but she replied by telling him he was late. The presence of the midwife who has taken the woman through virtually the entire pregnancy is important. This is about protecting both sides. If there is disagreement about what constitutes an area of low risk, for example, we need to discuss such matters. What determines low risk? What additional resources can we invest to ensure women in the medium risk category can avail of the same choices as women in the low risk category? We need to talk about such things. We cannot move away from indemnity. If something goes wrong and there is no insurance in place — we are fortunate that no such case has arisen to this point — those who are not insured will expect the State to pick up the tab. I must admit that if something happens to a mother or a child in such circumstances, I would not have a difficulty with the State picking up the tab. It is much better that we do this in an upfront manner. It is a question of looking at best international practice and saying "this is the best way to do this". If issues of risk need to be ironed out, we can do that as well. I am sorry I cannot accept Deputy Ó Caoláin's amendment. We disagree on very little, but this is an area of disagreement.
I would like to inform the Deputy that a national steering committee of home births has been established by the HSE to review the implications of the memorandum of understanding between the HSE and the self-employed community midwives regarding the provision of safe, evidence-based home birth services for low risk, healthy women. As I have said, this may also have application to women who are deemed to have a risk in the medium range. That is something we will have to examine. A wide range of stakeholders, including officials from the Department of Health, are represented on the national steering committee. The inclusive nature of the steering committee will facilitate discussion on the key areas of concern and will inform future guidelines and developments. That is where we are eventually going. If women who are deemed to have a higher risk than others wish to have their babies at home, it is a legitimate choice. We need to provide for additional services and supports to make that happen. Most definitely, we cannot allow people to operate in this area without having indemnity.
I am disappointed that the Minister of State, the Minister and those behind the legislation we are considering have decided they cannot accept this amendment, which I consider reasonable. It does not seek to force anyone's hand by making mandatory insurance applicable across those disciplines where it does not currently apply. It will be interesting to see whether the Minister, Deputy Reilly — I emphasise that he is a doctor — will be expeditious in bringing forward proposals to facilitate what the Minister of State has just advised us. We will watch this space with considerable interest in the time ahead.
The purpose of the proposed amendment to section 40 is to lift the statutory requirement. No one present argues that midwives should view indemnity insurance as an option. We are trying to cater to all circumstances which could arise and recognise the difficulties that currently apply.
A new EU directive on mandatory insurance will come into force after Easter. It will make unnecessary that for which the Minister of State argues. The cross-border health care directive will oblige member states to ensure proper indemnity is in place. In fairness to the European Union, of which I am not a fan, the directive recognises that fair and reasonable insurance must be in place before insurance can be made a legal requirement. This is not currently the case in Ireland.
I appeal again to the Minister of State on this issue. It is not the case that we are allowing a deficiency to continue. Things are being catered to but we should not single out midwives in terms of statutorily forcing on them a particular hand which does not apply to others. I do not believe it is the Minister's intention to apply it to them in the time ahead.
I have no doubt that both sides are well intentioned and hold sincere and firm views. The categories of women for whom community midwives will provide care can be addressed when we consider the criteria for a service level agreement. This issue must be considered. We cannot confine choices to women who are not at any risk. Other women also want to have choices.
Community midwives are different from other health professionals for many reasons, including, for instance, that they perform what in recent years has come to be viewed as a hospital based procedure. Our attitude to this issue will change, depending on how we dispose of this legislation. Frightening women into hospitals is a bad idea because child birth should be as natural as possible. However, we must insist that people are insured in circumstances in which an expectant mother is isolated and something can go wrong.
We have put forward all of the salient arguments that are known to me. I record my thanks to the various midwives and their representative groups who have spoken and corresponded with me in preparation for Report Stage of the Bill. I hope I have done justice to the arguments of which they have advised me. It is regrettable that we have not been able to reach agreement or have consensus and unanimity on the unacceptability of imposing a statutory requirement on midwives only. To my knowledge, a comparable provision does not apply to any other health profession. Enshrining such a requirement, as the Minister intends to do, does not have any purpose or point given that an alternative is provided, as we have clearly pointed out.
The amendment proposes to remove mandatory insurance from the legislation because midwives do not have access to insurance as of right. This point needs to be grasped and understood.
I appeal to all opinion in the House to recognise that the imposition of a statutory requirement is tantamount to victimisation — that is not too strong a word — of a single profession within the wide health care professions. I find that most objectionable and unacceptable. It does not achieve by any measure the stated goals in terms of protection for women in labour. The record shows unquestionably that midwives give exceptional care and are the first people women in labour trust and wish to be at their side in whatever setting presents. I recommend the amendment and propose to press it.
Question put: "That the words proposed to be deleted stand."
The Dáil divided: Tá, 90; Níl, 23.
Tá
- Bannon, James.
- Barry, Tom.
- Broughan, Thomas P.
- Browne, John.
- Burton, Joan.
- Butler, Ray.
- Buttimer, Jerry.
- Byrne, Catherine.
- Byrne, Eric.
- Carey, Joe.
- Coffey, Paudie.
- Conaghan, Michael.
- Conlan, Seán.
- Connaughton, Paul J.
- Conway, Ciara.
- Coonan, Noel.
- Corcoran Kennedy, Marcella.
- Creed, Michael.
- Creighton, Lucinda.
- Deenihan, Jimmy.
- Deering, Pat.
- Doherty, Regina.
- Dowds, Robert.
- Doyle, Andrew.
- Durkan, Bernard J.
- English, Damien.
- Farrell, Alan.
- Ferris, Anne.
- Fitzgerald, Frances.
- Fitzpatrick, Peter.
- Flanagan, Charles.
- Flanagan, Terence.
- Gilmore, Eamon.
- Hannigan, Dominic.
- Harrington, Noel.
- Harris, Simon.
- Heydon, Martin.
- Humphreys, Heather.
- Humphreys, Kevin.
- Keating, Derek.
- Keaveney, Colm.
- Kehoe, Paul.
- Kelly, Alan.
- Kenny, Seán.
- Kirk, Seamus.
- Kitt, Michael P.
- Kyne, Seán.
- Lawlor, Anthony.
- Lenihan, Brian.
- Lynch, Ciarán.
- Lynch, Kathleen.
- Lyons, John.
- McCarthy, Michael.
- McConalogue, Charlie.
- McFadden, Nicky.
- McHugh, Joe.
- McNamara, Michael.
- Maloney, Eamonn.
- Mathews, Peter.
- Mitchell O’Connor, Mary.
- Mulherin, Michelle.
- Murphy, Dara.
- Murphy, Eoghan.
- Nash, Gerald.
- Naughten, Denis.
- Neville, Dan.
- Nolan, Derek.
- Ó Fearghaíl, Seán.
- Ó Ríordáin, Aodhán.
- O’Donnell, Kieran.
- O’Donovan, Patrick.
- O’Dowd, Fergus.
- O’Reilly, Joe.
- O’Sullivan, Jan.
- Penrose, Willie.
- Phelan, Ann.
- Quinn, Ruairí.
- Rabbitte, Pat.
- Reilly, James.
- Ring, Michael.
- Ryan, Brendan.
- Shatter, Alan.
- Smith, Brendan.
- Stagg, Emmet.
- Timmins, Billy.
- Troy, Robert.
- Tuffy, Joanna.
- Twomey, Liam.
- Walsh, Brian.
- White, Alex.
Níl
- Boyd Barrett, Richard.
- Colreavy, Michael.
- Crowe, Seán.
- Daly, Clare.
- Doherty, Pearse.
- Donnelly, Stephen.
- Ellis, Dessie.
- Ferris, Martin.
- Flanagan, Luke ‘Ming’.
- Fleming, Tom.
- Healy, Seamus.
- Higgins, Joe.
- Mac Lochlainn, Pádraig.
- McDonald, Mary Lou.
- McGrath, Finian.
- McGrath, Mattie.
- McLellan, Sandra.
- Ó Caoláin, Caoimhghín.
- Ó Snodaigh, Aengus.
- O’Brien, Jonathan.
- O’Sullivan, Maureen.
- Ross, Shane.
- Stanley, Brian.
Tellers: Tá, Deputies Emmet Stagg and Paul Kehoe; Níl, Deputies Aengus Ó Snodaigh and Clare Daly.
Question declared carried.
Amendment declared lost.