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Dáil Éireann díospóireacht -
Tuesday, 11 Oct 2011

Vol. 743 No. 1

Nurses and Midwives Bill 2011: Report Stage (Resumed) and Final Stage

I move amendment No. 26:

In page 39, line 38, to delete "fine not exceeding €5,000" and substitute "class A fine".

Before we continue, I would be obliged if, in accordance with Standing Order 140, the Chair would direct the Clerk to make some verbal corrections to the text of the Bill. On pages 10, 23 and 36 of the Bill, there are references to names of Ministers or Departments that have changed since the Bill was published. Accordingly, I request the Chair to direct the Clerk to change the names of Minister and Departments as follows: to change "Minister for Health and Children" to "Minister for Health" on page 10, line 34; to change "Department of Health and Children" to "Department of Health" on page 23, lines 42 and 43, to change "Minister for the Environment, Heritage and Local Government" to "Minister for the Environment, Community and Local Government" in page 36, line 20.

Amendment agreed to.

I move amendment No. 27:

In page 41, line 39, to delete "fine not exceeding €5,000" and substitute "class A fine".

Amendment agreed to.

I move amendment No. 28:

In page 46, between lines 31 and 32, to insert the following:

"(4) A nurse or midwife who, at the time of registration did not have a relevant medical disability but develops a medical disability at any time after registration shall notify the Board when the medical disability becomes a relevant medical disability in that it develops to the point that it may impair his or her ability to practise nursing or midwifery, or a particular aspect of nursing or midwifery, not later than—

(a) 30 days after the medical disability becomes a relevant medical disability,

or

(b) where the relevant medical disability concerned renders it impracticable for the nurse or midwife to notify the Board within those 30 days, as soon as is practicable in the circumstances.

(5) Where the Board is satisfied, after receiving a notification under subsection (4), that in the interests of public safety, the registration of the nurse or midwife should become subject to conditions on the practising of nursing or midwifery, as the case may be, which take account of that relevant medical disability, the Board shall decide that conditions should be attached to the registration of the nurse or midwife in those interests, specify those proposed conditions and propose that the nurse or midwife accept that those conditions be attached to his or her registration.

(6) Where the nurse or midwife the subject of a decision under subsection (5) agrees in writing to the attachment of the proposed conditions, the Board shall attach those conditions to the registration of the nurse or midwife and at the same time comply with section 46(8) in respect of the conditions.

(7) Where the nurse or midwife the subject of a decision under subsection (5) refuses, in writing, to agree to the attachment of the proposed conditions, or does not respond within 30 days after receiving the decision from the Board, the Board shall make a complaint under section 55(1)(d).”.

Has this amendment already been discussed?

These are additional provisions for nurses and midwives who develop a relevant medical disability and I would like to record my support for the amendment.

Amendment agreed to.

I move amendment No. 29:

In page 47, line 39, to delete "and posts".

Amendment agreed to.

I move amendment No. 30:

In page 55, to delete lines 33 to 42 and in page 56, to delete lines 1 to 14 and substitute the following:

"62. —(1) The chief executive officer shall, as soon as practicable but not later than 30 days after a complaint is referred under section 61 to the Fitness to Practise Committee, give notice in writing to the registered nurse or registered midwife the subject of the complaint of the following:

(a) the referral of the complaint to the Fitness to Practise Committee;

(b) the opportunity for the nurse or midwife, or his or her representative, to be present and to defend the nurse or midwife at the hearing;

(c) the opportunity for the nurse of midwife to request that some or all of the hearing be held otherwise than in public if the nurse or midwife can show reasonable and sufficient cause;

(2) The chief executive officer shall, as soon as practicable after a complaint is referred under section 61 to the Fitness to Practise Committee, give notice in writing to—

(a) the registered nurse or registered midwife the subject of the complaint of the nature of the matter that is to be the subject of the inquiry, including the particulars of any evidence in support of the complaint, and

(b) any witnesses who may be required to give evidence at an inquiry (including, where appropriate, the complainant) of the opportunity for the witness to request that some or all of the hearing be held otherwise than in public if the witness can show reasonable and sufficient cause;

(3) The chief executive officer shall give notice in writing to the".

On Committee Stage, an amendment was accepted in regard to the chief executive officer having to notify the nurse or midwife and witnesses of certain information. The amendment included a time limit of 30 days. It has been brought to my attention that the inclusion of a 30 day limit is a matter of serious concern in regard to section 62, subsections (2)(a) and (2)(b). Subsection (2)(a) effectively requires that the notice of inquiry and book of documents be prepared and sent out within the 30 day timeframe. The book of documents includes all the documents it is proposed to rely on at the inquiry and is similar to the book of evidence in a criminal court case. This can take considerable time, needs to identify all the records and to examine all records and can include the requirement for production orders. Subsection (2)(b) relates to subsection (2)(a) in that witnesses might only be identified when all the relevant documents are examined.

Given that the 30 day time limit is unachievable for some subsections and the very serious risk that if the time stipulation was not adhered to it would be grounds for judicial review with a high likelihood of success on the part of the nurse or midwife and consequent collapse of the case against the nurse or midwife, I propose this amendment, which will split the notification into two parts, one which is subject to the 30 day time limit and the other which is not.

The amendment provides that the chief executive officer will notify the nurse or midwife within 30 days, first of the referral of the complaint to the fitness to practise committee, second of the opportunity for the nurse of midwife or his or her representative to defend the nurse or midwife at the hearing and third of the opportunity for the nurse or midwife to request that the hearing be held otherwise than in public.

The chief executive officer, as soon as is practicable, will give the nurse or midwife the nature of the matter, including the evidence, that is, the book of documents which includes all the evidence that will be used in the hearing. The chief executive officer will also notify any witnesses of the opportunity to request that the hearing be held otherwise than in public.

I urge Deputies to support this amendment.

This is a tidying up amendment. I accept the Minister's explanation.

Amendment agreed to.

Amendment No. 31 is consequential on amendment No. 32. Both may be discussed together by agreement.

I move amendment No. 31:

In page 56, line 20, before "sections” to insert “subsection (2) and”.

Amendments Nos. 31 and 32 provide that if a subcommittee of the fitness to practise committee is hearing a complaint, that subcommittee will include a nurse if the complaint concerns a nurse, and a midwife if the complaint concerns a midwife. Amendment No. 31 is a technical amendment to include a reference to the new subsection. Amendment No. 32 provides that when a subcommittee of the fitness to practise committee is conducting a hearing, that subcommittee will include a nurse if the complaint concerns a nurse, and a midwife if the complaint concerns a midwife.

I ask the Deputies to accept these amendments.

It is appropriate that, where a subcommittee of the fitness to practise committee is dealing with a nurse, a properly registered nurse should be a part of that hearing. The same is provided for where the hearing concerns a midwife. It is important that the midwives' profession be properly recognised and accommodated at such a hearing. I accept the Minister's position on both amendments.

Amendment agreed to.

I move amendment No. 32:

In page 56, between lines 20 and 21, to insert the following:

"(2) Where a subcommittee of the Fitness to Practise Committee is conducting a hearing of a complaint referred to that Committee—

(a) if the complaint concerns a registered nurse, at least one member of the subcommittee shall be a registered nurse, and

(b) if the complaint concerns a registered midwife, at least one member of the subcommittee shall be a registered midwife.”.

Amendment agreed to.

I move amendment No. 33:

In page 57, line 41, to delete "fine not exceeding €5,000" and substitute "class A fine".

Amendment agreed to.

I move amendment No. 34:

In page 62, lines 32 and 33, to delete "inappropriate behaviour" and substitute the following:

"non-compliance with a code of professional conduct".

On Committee Stage, an amendment was accepted that replaced the ground for complaint of inappropriate behaviour with non-compliance with a code of professional conduct. This amendment is required to correct the reference to "inappropriate behaviour" in section 75 with "non-compliance with a code of professional conduct" to reflect the Committee Stage amendment. I ask Deputies to support the amendment.

The new wording is more precise, clearer and better understood. The old wording is vague and open to a variety of interpretations. I accept the Minister's amendment. Clearer language makes for better legislation.

Amendment agreed to.

I move amendment No. 35:

In page 63, line 37, to delete "21 days" and substitute "28 days".

Amendment No. 35 extends the time a nurse or midwife has to pay an appropriate fee to the board, following a reminder being sent by the board, before the board can remove the nurse's or midwife's registration. The time is extended from 21 days to 28 days. I am of the view that this is sufficient time for a nurse or midwife to pay the fee, given that a reminder has already been sent and that there would have been an initial request for payment. I ask Deputies to support the amendment.

A period of 28 days is more reasonable and allows the leeway of an extra seven days to people who are in difficulty. I welcome the extension from 21 days to 28 days and I support the amendment.

Amendment agreed to.

I move amendment No. 36:

In page 73, lines 18 and 19, to delete "fine not exceeding €5,000" and substitute "class A fine".

Amendment agreed to.

Recommittal is necessary in respect of amendment No. 37 as it does not arise from Committee Stage proceedings.

Bill recommitted in respect of amendment No. 37.

I move amendment No. 37:

In page 79, to delete lines 14 to 18 and substitute the following:

107.—The Freedom of Information Act 1997 is amended—

(a) in the First Schedule—

(i) by substituting "Bord Altranais agus Cnáimhseachais na hÉireann" for "An Bord Altranais", and

(ii) by deleting "The National Council for the Professional Development of Nursing and Midwifery", and

(b) in the Third Schedule—

(i) by inserting "Nurses and Midwives Act 2011” in the second column of Part 1, and

(ii) by inserting "Section 17” in the third column of that Part.”.

This amendment corrects an error in the Bill in regard to the Freedom of Information Act. The Schedules of the Freedom of Information Act 1997 are amended. The amendment to the First Schedule allows for the new board name to be included in the list of bodies covered by the Freedom of Information Act and for the National Council for the Professional Development of Nursing and Midwifery to be removed, as this body is dissolved in this legislation and should no longer be included in the list of bodies in relation to the Freedom of Information Act.

The amendment also includes a provision to amend the Third Schedule, to provide that confidential information in section 17 of the Bill can be disclosed under the Freedom of Information Act. I ask Deputies to support the amendment.

I support the amendment.

Amendment agreed to.
Bill reported with amendments.
Question proposed: "That the Bill do now pass."

It is with considerable regret that I rise to record my opposition to the passage of the Bill, because there is much in it that I accept, support and welcome. I acknowledge that this is an important Bill, and thank the Minister, his officials and those who have participated in what was, when the Bill was first presented, a good debate in this House. I wrote to the Minister on 28 July from which followed an opportunity for me to participate in a meeting between Department of Health officials and the Community Midwives Association in regard to its serious concerns about the Bill, my support for which I have recorded on each Stage of the Bill.

In my letter of 28 July I asked the Minister to use the window of opportunity which presented from that point to today to take on board the valid and constructive amendments proposed by the Community Midwives Association which, at its request, I had placed before the him on Committee and Report Stages. The time between adjournment of the previous Report Stage debate and now was important. While I may well have received an acknowledgement of my letter of 28 July, I cannot find therein a response from the Minister on the matter, although I am open to correction on that point. An opportunity was missed.

I welcome the Minister's amendment in regard to freedom of information. My disposition in regard to much of the work done in this Bill is positive. However, the concerns of midwives regarding in particular the midwives committee and their representation and proper recognition in terms of their role and ability to practise as community midwives have not been recognised by the Minister, which is a serious deficiency in what is otherwise welcome legislation. The Community Midwives Association is not the only organisation to raise this issue. I have taken the time to engage at the highest level with the Irish Nurses and Midwives Organisation. While the two bodies do not necessarily concur on every point, I am at liberty to put on the record that the INMO shares the view of the Community Midwives Association that representation is key and that the midwives' profession, in terms of the midwives committee, has not been properly recognised and provided for in this legislation. That is most regrettable and feeds into the view that the role of midwives' is being undermined in what is otherwise a positive piece of legislation.

I do not intend to stretch this out unnecessarily. The Minister will be aware of specific concerns in regard to section 40, in respect of which I have received correspondence from the Community Midwives Association. The association also has concerns in relation to section 24. Section 40, which I have described as contentious and problematic, is wherein the key disappointment rests. There is a strongly held view that this provision could severely curtail the ability of women to have access to midwife-led child birth. This has long term implications for child birth in this State given the overcrowding in our maternity hospitals and the loss of maternity units in different hospital locations countrywide, including in my native Monaghan. For these reasons, it would be inappropriate for me and my party to, at this point, fold up the arguments we have strenuously made on every Stage of this legislation. I would like to support this legislation and do so in respect of much of what is contained therein but it is important to be consistent. I have taken a stand and will, with regret, hold to that stand and oppose the passage of this Bill because of the Minister's failure to take on board the reasonable and well articulated arguments put forward by the Community Midwives Association representatives.

While undoubtedly the Bill will be passed this evening, it is hoped that the Minister will indicate to the House in his concluding remarks that these matters will be addressed in the future as clearly they are not now going to be addressed in the Nurses and Midwives Bill 2010.

I, too, met with the Community Midwives Association. I commend the purpose of the Bill which is to enhance the protection of the public in its dealings with nurses and midwives. However, I have some serious reservations about it.

A letter from the Community Midwives Association, which I am sure the Minister, too, received, sets out its grave concerns in regard to sections 24 and 40. The letter states the association believes there is too much scope for misuse and misunderstanding of the current wording and a recognised lack of consensus among all those involved, which is far from reassuring. As stated by my colleague, Deputy Ó Caoláin, the Community Midwives Association has serious concerns about sections 24 and 40. By my interpretation, section 40 denies women the right to opt for a psychological service which would be low-tech and drug free, a right effectively recognised by the European Court of Human Rights.

I welcome many aspects of the Bill and acknowledge and admire the efforts made by the Minister, as compared with the previous Administration, to progress this legislation. However, I have some serious reservations about sections 24 and 40.

I regret that Deputy Ó Caoláin does not see fit to support the Bill. While I hear what he says, the Deputy's first amendment seeks to provide that the sub-committee or committee's advice would have a binding effect on the board. I do not believe that applies anywhere. The full board must make the final decision and must have the right to be the final arbiter. Acceptance of the amendment would be contrary to good governance. The board is responsible and accountable for decisions made by it. It cannot be overruled or bound by a decision of the committee of the board. To provide that a committee may have a majority of members who are not members of the board and may not be aware of the wider implications in relation to matters on which the committee is advising would be to undermine decisions of the main board having a binding effect on the board. I regret to say that we could not allow that.

The Deputy also tabled an amendment which proposes the removal of the provision that a registered midwife must have adequate clinical indemnity insurance to attend a woman in child birth for reward. On this issue, I will be as immovable as a rock. There is no way I will allow the situation to pertain in this country that professionals attending at a birth would not be indemnified. With the best will in the world, things can go wrong. I will qualify what I am saying with the following. I accept that child birth is a natural phenomenon. Where it is safe to have a birth at home, I would be fully encouraging of it. However, to ask that the Government would preside over a situation whereby a professional attending at a birth would not be indemnified, thus exposing woman and child, were a misadventure occurred, to a situation wherein they would have no recourse to any compensation or assistance is beyond my conscience. It is not something I could even countenance.

I regret that proposal is completely ultra vires as far as I am concerned. The only area wherein we seek to have them indemnified is around the birth. Psychological support and so on is not an issue. I cannot accept either of the Deputy’s amendments. I nevertheless thank Members opposite, many of whom have been supportive, for the reasoned debate on this legislation.

The Community Midwives Association made it clear in the correspondence referred to by Deputy Halligan that it felt there was too much scope for misuse and misunderstanding in the current wording of the legislation and a recognised lack of consensus among all those involved which was far from reassuring. It emphasised that at no point did its membership wish to be uninsured but that the opposite was the case.

It is important to bear in mind that the issue at stake is not about being insured or indemnified but the actual present wording and its possible interpretation.

That engagement and the concerns by the Community Midwives Association about the interpretations of the sections in question have not been addressed. The midwives are not looking to have an uninsured status. They are more than well informed of the importance of indemnification.

I concur with my colleague, Deputy Ó Caoláin. The association said, as currently worded, the Bill is not the best arrangement for mother and midwife. It also pointed out how the sections in question do not take account of their members' professionalism, the nature of their business and best practice. Additionally, these sections do not allow for the potential removal of insurance due to factors beyond their members' control. This means they are not treated like other allied medical professionals but could actually be criminalised by the provision.

All the midwives I spoke to empathically told me they have no problem with being insured but do have concerns over the wording of the Bill. I am sure this difficulty was spelled out in detailed correspondence to the Minister. I must take on board their deep unhappiness with these aspects of the Bill. I do not want to vote against this legislation because of the huge effort made by the Minister to introduce it. However, based on my correspondence with the Community Midwives Association, I must acknowledge their unhappiness with certain provisions.

I accept the point about the unhappiness of the Community Midwives Association. However, amendment No. 25 sought to remove the provision that a registered midwife must have adequate clinical indemnity insurance. Since the correspondence on this section began, the association has had several meetings with the Department during which it made the suggestion its members would be insured attending any childbirth. I do not believe this is appropriate in cases where the birth would more properly take place in a hospital because it was identified as high-risk.

After the passage of the Bill I will be prepared to continue to engage with the Community Midwives Association. The Health Service Executive has established a national steering committee of home births to review the implications of the memorandum of understanding between the HSE and self-employed community midwives on the provision of a safe, evidence-based home-birth delivery service for low-risk healthy women. The committee consists of representatives from a wide range of stakeholders along with the Department of Health. The committee's inclusive nature will facilitate discussion around the key areas of concern and will inform future guidelines and developments.

We support home deliveries when they are safe, along with the Community Midwives Association. I accept the association's concerns but the Bill must pass as drafted. I am happy to continue to discuss the association's concerns.

Question put.
The Dáil divided: Tá, 80; Níl, 24.

  • Barry, Tom.
  • Browne, John.
  • Butler, Ray.
  • Byrne, Catherine.
  • Byrne, Eric.
  • Calleary, Dara.
  • Collins, Áine.
  • Conaghan, Michael.
  • Conlan, Seán.
  • Connaughton, Paul J.
  • Conway, Ciara.
  • Corcoran Kennedy, Marcella.
  • Costello, Joe.
  • Coveney, Simon.
  • Creed, Michael.
  • Daly, Jim.
  • Deasy, John.
  • Deering, Pat.
  • Doherty, Regina.
  • Donohoe, Paschal.
  • Durkan, Bernard J.
  • English, Damien.
  • Farrell, Alan.
  • Feighan, Frank.
  • Ferris, Anne.
  • Fitzpatrick, Peter.
  • Flanagan, Charles.
  • Fleming, Sean.
  • Grealish, Noel.
  • Harrington, Noel.
  • Harris, Simon.
  • Hayes, Brian.
  • Heydon, Martin.
  • Howlin, Brendan.
  • Humphreys, Heather.
  • Humphreys, Kevin.
  • Kehoe, Paul.
  • Kelleher, Billy.
  • Kitt, Michael P.
  • Kyne, Seán.
  • Lawlor, Anthony.
  • Lynch, Kathleen.
  • Lyons, John.
  • McConalogue, Charlie.
  • McEntee, Shane.
  • McFadden, Nicky.
  • McGinley, Dinny.
  • McGuinness, John.
  • Maloney, Eamonn.
  • Mitchell, Olivia.
  • Mitchell O’Connor, Mary.
  • Mulherin, Michelle.
  • Murphy, Dara.
  • Murphy, Eoghan.
  • Nolan, Derek.
  • Noonan, Michael.
  • Ó Cuív, Éamon.
  • O’Donnell, Kieran.
  • O’Donovan, Patrick.
  • O’Mahony, John.
  • O’Reilly, Joe.
  • O’Sullivan, Jan.
  • Penrose, Willie.
  • Perry, John.
  • Phelan, John Paul.
  • Rabbitte, Pat.
  • Reilly, James.
  • Ryan, Brendan.
  • Sherlock, Sean.
  • Shortall, Róisín.
  • Smith, Brendan.
  • Stagg, Emmet.
  • Stanton, David.
  • Timmins, Billy.
  • Troy, Robert.
  • Tuffy, Joanna.
  • Twomey, Liam.
  • Wall, Jack.
  • Walsh, Brian.
  • White, Alex.

Níl

  • Adams, Gerry.
  • Boyd Barrett, Richard.
  • Collins, Joan.
  • Crowe, Seán.
  • Daly, Clare.
  • Doherty, Pearse.
  • Donnelly, Stephen.
  • Ferris, Martin.
  • Fleming, Tom.
  • Halligan, John.
  • Healy, Seamus.
  • Healy-Rae, Michael.
  • Higgins, Joe.
  • McDonald, Mary Lou.
  • McGrath, Finian.
  • McGrath, Mattie.
  • McLellan, Sandra.
  • Murphy, Catherine.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Sullivan, Maureen.
  • Pringle, Thomas.
  • Ross, Shane.
  • Tóibín, Peadar.
Tellers: Tá, Deputies Emmet Stagg and Paul Kehoe; Níl, Deputies Aengus Ó Snodaigh and Catherine Murphy.
Question declared carried.

The Bill will now be sent to the Seanad.

Sitting suspended at 6.40 p.m. and resumed at 7.30 p.m.
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