Some eleven years ago this House had before it a Bill to replace the legislation which at that time existed for the training and registration of nurses and midwives. This Bill became law as the Nurses Act, 1950. Under this measure a new body, An Bord Altranais, was set up in June, 1951, to deal with the training and registration of nurses and midwives. The purpose of the present Bill is to make certain changes in its provisions which experience has indicated are desirable.
Section 2 of the Bill will clear up a doubt as to the law governing the election of nurses to membership of An Bord Altranais. Under the 1950 Act, ten persons are elected for a five-year term of office to be members of An Bord. The Act provides that some of those to be elected must be persons with midwifery qualifications, some mental nurses and other nurses with general qualifications. The procedure for election is governed by rules made by An Bord Altranais with the consent of the Minister for Health. The rules thus made—the Nurses Rules, 1953— provide that the total electorate of nurses will be divided so that those on the general part of the Register will elect the general nurses, those qualified as midwives will elect the midwife members, and those whose names are on the Mental Nurses Division will elect the mental nurses to An Bord. This arrangement seems to have been entirely acceptable to the nursing profession and, for myself, I cannot see any ground for objecting to it. However, doubts have arisen as to whether there was, in fact, power in the original Act to divide the electorate in this fashion. The purpose of Section 2 of the Bill is to put it beyond doubt that there was such a power.
Section 3 will make good an oversight in the drafting of the 1950 Act by providing that members of An Bord may be paid travelling and subsistence expenses when they travel on An Bord's business, as for example, in the visitation of hospitals.
The present arrangements for financing An Bord have for some time been regarded as unsatisfactory by the Minister for Finance and by myself. Under Section 59 of the 1950 Act there is an obligation on the Minister for Health to meet whatever deficit is incurred in any year by An Bord. Subsequently, one half of this deficit is recovered by the Minister from local health authorities. It is mandatory on the Minister to meet the deficit—whatever it may amount to—and he cannot curtail the amount which he will recoup in respect of any year. He has certain powers to control the expenditure of An Bord— its annual Estimates are subject to his approval, as are the amounts of salaries paid to the staff and fees paid to examiners—but he has no corresponding powers to ensure that the revenue raised by An Bord will meet any set proportion of their costs.
There is a further disadvantage— this time from An Bord's point of view—in the present procedure in that it receives no grant for any year until the accounts for that year have been audited. An Bord, therefore, must continuously await payment of the deficit for each preceding year and is thus compelled to work for a considerable part of the time on overdraft, a rather expensive procedure, as most Senators will recognise.
The new procedure under Section 4 of the Bill, which will replace Section 59 of the 1950 Act, is that the Minister, while still being obliged to pay grants to An Bord, will, in consultation with An Bord and the Minister for Finance, determine in advance what the grant for any year will be and will not be governed, as at present, by a requirement to meet, post factum, the deficit for each year. This provision will be more in consonance with the Minister's responsibilities to the Oireachtas for public moneys than the present system.
Section 5 is a corollary to the new provision for the payment of grants and will require An Bord to fix the amount of fees payable to them so that it will collect each year sufficient money to meet the part of its expenditure which the grant does not defray. The changes to be made under Sections 4 and 5, I would like to emphasise, are not designed to save money for the Exchequer but to establish a more satisfactory principle and procedure in the financing of An Bord.
Section 6 will repair an omission in the 1950 Act by giving the Minister a statutory power to require An Bord to give him information. The provision will put the law in this respect in relation to this board into line with the general position of other statutory bodies in this regard.
At present, under Section 16 of the 1950 Act, the members of An Bord Altranais each year elect one of themselves to act as President for the ensuing year. Section 7 of the Bill proposes that future Presidents will be appointed by the Minister from the members of An Bord and that their term of office will be five years, which is the term of office of the members of An Bord. There are, to my mind, sound reasons for these proposals.
An Bord Altranais is set up under statute, in legislation sponsored by the Minister for Health; the rules which it makes are subject to his approval; and his consent is required to a variety of its activities. In addition, he supplies it with substantial funds annually and will continue to do so. In fact it is clear from the provisions of the 1950 Act taken as a whole that in relation to all its functions An Bord acts as the instrument or agent of the Minister for Health, who if he sees fit to do so may appoint another body or even a person to act in its stead. It is essential, therefore, that harmony and understanding should exist between the body and the Minister and that it should readily co-operate with him in the fulfilment of his statutory obligations under the Act. One of the qualifications which the President of any statutory board must possess is ability to establish such relations with the responsible Minister so that through him an effective and cordial liaison may be maintained between the Minister and the board. A wide experience indicates that this position is most likely to be attained when the President of the body holds his appointment directly from the Minister to whom he is responsible.
In so far as the term of office is concerned, it appears to me that the balance of advantage is heavily in favour of the President's period of office being co-incident with the life of a particular board. Over a five-year period, a President will have time to initiate projects and bring them to fruition in a way which would not be possible for a President whose term of office lasted for only a year.
Section 8 and the repeal Schedule are consequential on earlier provisions of the Bill and also make a minor change by absolving An Bord from an existing obligation to provide midwives with special badges, while continuing An Bord's power to issue such badges as they consider necessary for midwives and other different categories of nurses.
I recommend the Bill to the Seanad.
