Nurses and Midwives Bill 2010: Committee Stage

I welcome the Minister for Health and Children, Deputy Harney, and her officials. The suggested timeframe for our deliberations is that we continue until 1.30 p.m. at the very latest. One hopes that with everyone's co-operation, notwithstanding the importance of the matters before the committee, members can conclude their deliberations within that timeframe. A briefing note and an amendment list have been circulated to members for their information.

I must step out of the meeting at approximately 11.30 a.m. Is it agreed that Deputy Conlon will then take the Chair? Agreed.

Section 1 agreed to.
SECTION 2

Amendments Nos. 1, 7, 8, 12, 14, 15, 38, 40, 42 to 53, inclusive, and 56 to 58, inclusive, have been grouped and will be discussed together.

I move amendment No. 1:

In page 10, subsection (1), to delete lines 6 to 20.

I will outline briefly the rationale for the removal through these amendments of the provisions dealing with the regulation of advanced nurse-midwife practitioners and related posts. The Bill currently provides for the registration of advanced midwife practitioners and advanced nurse posts and the registration of advanced nurse-midwife practitioners, including a link between a post in employment and the individual, as well as protection of these titles. These provisions were included to formalise the arrangements that had been operated for a number of years by the national council. They were designed to ensure patient safety by setting the necessary independent national standard structures and criteria for both the posts and the individuals who occupied them. The purpose of registering the post was driven by the fact that it was always considered to be essential that the advanced practitioner would be facilitated with all the necessary supports and governance arrangements when engaging in advanced practice.

Following the Second Stage debate and on foot of representations from all sides of the House, I have had these provisions re-examined. An Bord Altranais, the regulatory body for nurses; the Health Service Executive; the Irish Association of Directors of Nursing and Midwifery; the unions representing the nursing professionals and so on considered the provisions to be unnecessary and that more appropriate arrangements could be put in place to ensure the necessary regulatory framework. It was argued by the relevant stakeholders that the envisaged provisions would be unique to Ireland. There was a particular concern regarding the provisions that required an advanced practitioner to be employed or to have an offer of employment in an advanced practitioner post before he or she could be registered as an advanced practitioner in the register of nurses and midwives. It was strongly believed that these provisions were unnecessary, lacked flexibility and could cause difficulties in terms of, for example, succession planning.

Having considered the representations, I propose to remove the provisions on advance practice, both to advanced nurse-midwife practice posts and the individuals concerned. As an alternative, it is intended that the board will regulate the individual advanced nurse-midwife practitioners in public and private health care settings by setting the requirements and standards with the education programmes, the practice standards and the necessary scope of practice relevant to those practitioners. It is intended that the HSE will have a central role in ensuring the necessary governance arrangements are in place for advanced posts for the public health sector. It is envisaged that, in the future, that will form part of the licensing and broadening of the Health Information and Quality Authority's remit to the private sector. The proposed amendments and deletions collectively provide for the removal from the Bill of all the relevant provisions and, therefore, deal with the Opposition Deputies' amendments in this instance.

I welcome the Minister's opening statement. So many amendments were necessary at the outset because people had significant concerns about over-regulation and the fact that, had the Bill been passed as drafted, certain people would not have been registered and, as such, would not have had the cover of legislation. Clearly, the Department has been listening to the groups involved and there has been a significant level of discussion. I hope we can proceed in the same way.

We are discussing amendment No. 1 together with the 22 other grouped amendments. Deputy Reilly might care to address those matters.

My apologies for being late.

Amendments Nos. 51 and 52 are in Deputy Reilly's name.

What we are doing is decoupling the person from the need to have the post, which was a strong opinion put forward by the Deputies opposite, members of the Government parties, An Bord Altranais, the HSE and the unions representing the different branches of the nursing profession. Some time ago, I held a large meeting in my office to discuss this issue because the level of representation was so high. The large number of amendments reflects the outcome of those discussions.

Is Deputy Reilly satisfied?

I also welcome the amendment. It is a more practical way of dealing with the issue.

Amendment agreed to.

If amendment No. 2 is agreed, amendment No. 3 cannot be moved. Amendments Nos. 2, 3, 11 and 16 are being grouped and may be discussed together by agreement.

I move amendment No. 2:

In page 10, subsection (1), to delete lines 33 to 42.

Our amendment No. 3 proposes, in page 10, subsection (1), to delete lines 32 and 43 and substitute the following:

" "clinical supervising authority" in relation to a midwife, means a person or body which the Board appoints under the rules to be the clinical supervising authority, after consulting the midwife concerned, not being the midwife's direct employer;

I hope the Minister will understand our argument, which is straightforward. Having one's direct employer deal with an issue like this is difficult. Since the Bill refers to the board and how it will deal with procedures, our amendment seems to be more practical than anything else. I hope the Minister will view it in that respect.

Given my amendment, amendment No. 3 is unnecessary, as it would achieve the same thing. I agree with the Deputy in that respect.

Yes. I thank the Minister.

Amendment agreed to.
Amendment No. 3 not moved.

I move amendment No. 4.

In page 12, subsection (1), line 13, to delete "name is entered in the nurses division of the" and substitute "name is entered in the".

This is a technical amendment to amend the definition of "registered nurse" by removing the reference to "nurses division". This only applies to nurses with Part 8 registration and was a technical matter drawn to our attention.

Amendment agreed to.
Section 2, as amended, agreed to.
Section 3 agreed to.
SECTION 4

Amendments Nos. 5 and 84 are related and may be discussed together by agreement.

I move amendment No. 5:

In page 13, lines 21 to 27, to delete subsections (3) and (4).

These are drafting amendments proposed by the Parliamentary Counsel to improve the structure of the Bill. They provide for the removal of subsections (3) and (4) from section 4. Instead, a new section is being created that will contain the construction of all references, including the construction of two deleted references from section 4.

Amendment agreed to.
Section 4, as amended, agreed to.
Sections 5 to 7, inclusive, agreed to.
SECTION 8

Amendments Nos. 6 and 86 are related and may be discussed together by agreement.

I move amendment No. 6:

In page 15, lines 31 and 32, to delete all words from and including "the" where it thirdly occurs in line 31 down to and including "and" where it secondly occurs in line 32 and substitute the following:

"the promotion of excellence in nursing and midwifery and the protection of the public in connection therewith and".

The wording of the Bill is overly politically correct, if one can be overly politically correct in the Chamber. Apart from exceptional circumstances, which thankfully are rare, most midwives and nurses work to the benefit of the patient, but the Bill starts off by saying that the public must be protected. The amendment is about the language more than anything else.

The main purpose of the Bill is the protection of the public. It is a regulatory body for nurses. The Deputy's amendment would delete the provision on the protection of the public. However, I am prepared to examine the matter on Report Stage, as we could incorporate the provision on excellence without getting rid of the main purpose of the Bill. I was sympathetic when I saw the wording, but I do not want to delete the main purpose, which is the protection of the public. That is in order.

We do not want the Minister to do that.

I will revert to the matter on Report Stage.

I thank the Minister. If I could recommit on Report Stage, I would be prepared to let the amendment go.

Amendment, by leave, withdrawn.
Section 8 agreed to.
SECTION 9

I move amendment No. 7:

In page 16, subsection (2), to delete lines 1 to 5, and substitute the following:

"(a) establish and maintain the register of nurses and midwives and the candidate register,

(b) establish procedures and criteria for assessment and registration in the register of nurses and midwives and the candidate register, and the”.

The proposed amendment imposes a statutory obligation on the board to produce a code of professional conduct for nurses and midwives. This code will enhance the protection of the public by outlining clearly the professional conduct expected from nurses and midwives. Members may remember the references on Second Stage to disciplinary procedures for inappropriate behaviour. People had real issues with the provision, so we are deleting it. There will be a reference later on. The code of practice allows us to be able to delete the reference to inappropriate behaviour, so nurses will be obliged to abide by a code of professional practice, which everyone would regard as acceptable.

Amendment agreed to.

Due to the agreement of amendment No. 7, amendment No. 8 in the names of Deputies Kathleen Lynch and Jan O'Sullivan cannot be moved.

Amendment No. 8 not moved.

I move amendment No. 9:

In page 16, subsection (2)(e)(i), line 16, to delete “States” and substitute the following:

"States or other relevant states within the meaning of the Regulations of 2008".

This is a technical amendment to ensure that the mutual recognition of professional qualifications of nurses and midwives reflects the states covered by EU Directive 2005/36/EC, which is transposed by SI 164 of 2008 on the recognition of the professional qualifications of nurses of midwives.

Amendment agreed to.

I move amendment No. 10:

In page 16, subsection (2)(g), to delete lines 35 to 39 and substitute the following:

"registered midwives, including the establishment, publication, maintenance and review of—

(i) appropriate guidance on all matters related to professional conduct and ethics for registered nurses and registered midwives,

(ii) appropriate guidance on the maintenance of the professional competence of registered nurses and registered midwives, and

(iii) a code of professional conduct for registered nurses and registered midwives,".

Amendment agreed to.

I move amendment No. 11:

In page 17, subsection (2)(l), lines 6 to 11, to delete all words from and including “of” in line 6 down to and including “and” in line 11 and substitute “of this Act, and”.

Amendment agreed to.
Section 9, as amended, agreed to.
Sections 10 to 12, inclusive, agreed to.
SECTION 13

I move amendment No. 12:

In page 19, subsection (2)(b), to delete line 13 and substitute “midwives and the candidate”.

Amendment agreed to.

I move amendment No. 13:

In page 19, subsection (2)(b), line 14, to delete “be maintained” and substitute “be established and maintained”.

This amendment clarifies that the board's power to make rules on the formal manner of the register includes how the register will be established in addition to maintaining those registers.

Amendment agreed to.

I move amend No. 14:

In page 19, subsection (2)(I), lines 33 and 34, to delete all words from and including “midwives,” in line 33 down to and including “posts” in line 34 and substitute “midwives and the candidate”.

Amendment agreed to.

I move amendment No. 15:

In page 19, subsection (2)(k), lines 42 and 43, to delete all words from and including “nurses” in line 42 down to and including “posts” in line 43 and substitute “nurses and midwives or the candidate”.

Amendment agreed to.

I move amendment No. 16:

In page 20, subsection (2), lines 4 to 12, to delete paragraph (n) and substitute the following:

"(n) the specification of standard governance frameworks for midwives, including the requirement for indemnity insurance for midwives,”.

Amendment agreed to.

Amendments Nos. 17, 18 and 22 are related and may be discussed together by agreement.

I move amendment No. 17 :

In page 20, subsection (4)(c), to delete lines 39 and 40.

The IMO makes the argument, and it is well made, that the concept of linking membership of a register to holding a post is not an appropriate model. The Minister was sympathetic to this in her opening statement.

Are we discussing amendment No. 17?

Amendment No. 17 has to do with the requirement for the Minister for Finance to approve draft rules, which is common throughout the Government. If rules are to have an impact on the public finances I am afraid the Minister for Finance of the day - as has been common for many years - will have to at least see those proposals and, with the Minister for Health and Children, approve them. The purpose of the amendment is to delete the reference to the Minister for Finance.

I am afraid I cannot do that; I am not free to do so. It would be unfair of any line Minister to introduce a proposal that had implications for the public finances without the approval of the line Minister who would have to make money available, namely, the Minister for Finance. It is common throughout legislation. It is not only in this area that it happens.

I will press the amendment.

Amendment put and declared lost.

I move amendment No. 18:

In page 21, subsection (6), line 6, to delete "and the Minister for Finance".

The same applies to this amendment as to amendment No. 17 as they are related.

Amendment, by leave, withdrawn.
Section 13, as amended, agreed to.
Sections 14 and 15 agreed to.
SECTION 16

I move amendment No. 19:

In page 23, line 15, to delete "indictable".

I cannot accept this amendment as it would require the CEO of the board to notify the Garda or the Director of Corporate Enforcement with regard to a minor offence. The purpose of the Bill is that the Garda be informed of an indictable offence or that the Director of Corporate Enforcement be informed in the case of a nurse running a nursing home. However, for something minor it would be unnecessary and unfair. It would lead to much time being wasted by the Garda and the Director of Corporate Enforcement. The idea is that where the board becomes aware of a serious matter which would be an indictable offence it has an obligation to inform the authorities, which would include the Garda and the Director of Corporate Enforcement. If it were a more minor matter then that obligation would not be on it.

The concern is about who determines what is a minor matter.

An indictable offence is specified; it would be a possible criminal matter. A minor offence could be not keeping books or the books not being in order - I am talking off the top of my head - and to require the CEO of An Bord Altranais every time something comes to his or her attention about a nurse or midwife to have to go to the Garda or the Director of Corporate Enforcement is unnecessary. Many of the issues that might be brought to his or her attention could be very minor. It would also be unfair on the professionals, to be honest.

We need to have a sense of perspective and perhaps the intent was misunderstood. The idea is that where something serious that is indictable which could carry a prison sentence comes to the board's attention it should be brought to the attention of the Garda or the Director of Corporate Enforcement at the earliest possible opportunity. However, where it is something relatively minor, and many complaints are minor and sometimes do not stand up when they are properly examined, it would be unfair to put that onus on the CEO of the board or have the nurse who is the subject of a minor complaint subject to inquiry by the Garda or the Director of Corporate Enforcement.

Amendment, by leave, withdrawn.
Section 16 agreed to.
Section 17 agreed to.
SECTION 18

I move amendment No. 20:

In page 24, subsection (1)(a), line 23, before “prepare” to insert the following:

"following consultation with the nursing and midwifery professions in a form and manner decided by the Board,"

I am sympathetic to this amendment and I will consider it prior to Report Stage.

I am happy with that.

Amendment, by leave, withdrawn.
Section 18 agreed to.
Sections 19 to 21, inclusive, agreed to.
SECTION 22

Amendments Nos. 21 and 25 are related and will be discussed together.

I move amendment No. 21:

In page 27, subsection (1), line 39, after "Minister" to insert the following:

"subject to the approval of a joint Oireachtas committee assigned the role of examining matters relating to health and children".

This country has had a long history of self-confessed explanations of how people have ended up on boards because they happen to be friends with someone as opposed to having any particular competence or skill. To ensure transparency, appointments of this nature should come through an Oireachtas committee and in this case the Oireachtas Joint Committee on Health and Children would be the appropriate forum. It would be to ratify and to ensure the appropriate people are appointed.

Two issues are raised. Many of the board members will be elected by various branches of the nursing profession. However, public interest people will be appointed by the Minister and I am happy to consider this prior to Report Stage. I do not disagree with Deputy Reilly. I would like to think the people we appoint would be acceptable to everybody.

I accept what the Minister has stated.

Amendment, by leave, withdrawn.

Amendments Nos. 22, 24, 79 and 81 are related and may be discussed together by agreement.

I move amendment No. 22:

In page 27, subsection (1)(a), line 46, to delete “and Science” and substitute “and Skills”.

These amendments are to take account of the changed name of the Department of Education and Science to the Department of Education and Skills.

Amendment agreed to.

I move amendment No. 23:

In page 28, subsection (1)(d), line 38, to delete “Act 2007” and substitute the following:

"Act 2007 and who is not and never has been a registered nurse or registered midwife in the State or in another jurisdiction".

Section 22 provides for some members of the board to be nominated by a variety of stakeholders and bodies. In particular, section 22(1)(d) provides for one person to be nominated by the Medical Council whose name is entered on the register of the medical practitioners maintained under the Medical Practitioners Act. We want to ensure this is not somebody who was nurse and then became a doctor because the idea is to have a non-nurse lay majority. It is a technical issue.

Amendment agreed to.

I move amendment No. 24:

In page 28, subsection (1)(e), line 40, to delete “Science from” and substitute “Skills from”.

Amendment agreed to.

I move amendment No. 25:

In page 29, subsection (1)(j)(ii), line 26, after “appropriate,” to insert the following:

"and after receiving the approval of a committee of the Houses of the Oireachtas designated by the Houses for that purpose,".

This has already been discussed with amendment No. 21.

It concerns an indictable offence. I cannot accept the amendment.

I accept what the Minister has said.

Could we have some clarification on this?

We have already discussed it but I will allow the Deputy to contribute if he is brief.

The Minister indicated when speaking on amendment No. 21 that she would be sympathetic to this amendment.

We will come back to it on Report Stage.

Yes, I will come back to it on Report Stage. There are two different amendments, with one relating to the public interest and the other relating to everybody else. We should accept those elected by the profession. With regard to those subject to nomination by the Minister, I am happy for them to come back to the Oireachtas committee. I will come back with a Report Stage amendment.

Amendment put and declared lost.

I move amendment No. 26:

In page 29, lines 28 to 30, to delete subsection (2) and substitute the following:

"(2) At its first meeting, the Board shall elect a person to the position of President of the Board for the first term mentioned in the Schedule.".

It is very important that there be no hint of political interference or influence with a statutory body like this. For the Minister to have the right to appoint the chair would not apply in the Medical Council or other councils I am aware of. This is not sending the right signal. I contend it would be better for the board to elect the president or chairperson.

I am happy to have a look at this and I am open to suggestion. I assure the Deputy that the intention was not to have any political interference; it came from the strong advice from people that the new board would see major transformation in terms of function. It is not an unreasonable amendment and I will either accept it or come back on Report Stage once we have a look at it.

Amendment, by leave, withdrawn.

Amendment No. 27 is the names of Deputies Jan O'Sullivan and Kathleen Lynch. Amendment No. 35 is related and both amendments may be discussed together by agreement.

I move amendment No. 27:

In page 29, subsection (5)(b), lines 44 and 45, to delete

", or

(c) a member of a local authority.”.

Does the Deputy wish to comment on the amendment?

It is self-explanatory and refers to the removal of any kind of political input into committees. I am not a person who believes these should be overly political but we should ultimately have the best people for the job. Somebody must speak up for the political process.

I have mixed views on this. We spoke earlier about the politicisation of the board and the issue arises as to whether a politician should be capable of being elected to the board or an employee of the board. It is common to medical practitioners and health Acts, as well as many other pieces of legislation. It is something councillors in particular feel strongly about and perhaps we could reflect on the amendment. We might distinguish between the board and employees of the board. It is preferable for the board to consist of independent people rather than be aligned to a political cause. That is my view, which is probably the view of the professions.

I agree with the Deputy that there is a large number of councillors in our community, some of whom are active in this space. Could we agree to reflect on the matter between now and Report Stage? There are mixed views on this.

Amendment, by leave, withdrawn.
Section 22, as amended, agreed to.
Section 23 agreed to.
SECTION 24

Amendment No. 28 is in the names of Deputies Jan O'Sullivan and Kathleen Lynch. Amendments Nos. 29 and 30 are related, therefore, amendments Nos. 28 to 30, inclusive may be discussed together by agreement.

I move amendment No. 28:

In page 30, subsection (2)(b), line 23, after “complaints,” to insert the following:

"which shall include a Registered Nurse in any case where the complaint relates to a nurse, and which shall include a Registered Midwife in any case where the complaint relates to a midwife,".

This grouping takes in amendments Nos. 28 to 30, inclusive. Deputy Reilly has put forward amendment No. 30. I am sympathetic to these amendments and I would like to return to them on Report Stage.

I spoke to a constituent yesterday who was worried because she has four children, with three born at home. She wants to know if this excludes midwives when women choose to have children at home.

We will deal with this later.

I am sorry if this is the wrong time.

They must have appropriate insurance but we will deal with it later. We are bringing them in under this legislation so that when somebody has a birth at home, if something goes wrong the patient should be appropriately insured. We are not excluding midwives.

They are not excluded.

No, but there must be appropriate supervision and insurance. The Deputy does not need me to tell him that if there is a serious brain injury at birth, there are significant sums paid out in court. If somebody is at home in that kind of position with no insurance, the mother and family will be extremely vulnerable. We cannot leave it unregulated.

The choice still exists under certain regulations.

If there are appropriate regulations and insurance, the choice remains. I should have said that amendment No. 29 deals with being a member of a board. All boards, including the Medical Council, would need flexibility to bring people into sub-committees. The onus of work is such that it is not possible to get board members to sit at all the hearings. We are providing for the Medical Council to have people on sub-committees who are not members of the board. That would be the intent of the first amendment and Deputy Reilly's amendment, but amendment No. 29 would prohibit that. The strong advice is the amendment is too restrictive. The process of the Medical Council is working well.

I support the Minister in that.

I will come back on Report Stage to deal with the issues in amendments Nos. 28 and 30.

Amendment, by leave, withdrawn.
Amendments Nos. 29 and 30 not moved.
Section 24 agreed to.
Sections 25 to 27, inclusive, agreed to.
SECTION 28

Amendment No. 31 is in the name of the Minister. Amendment No. 34 is related and both amendments may be discussed together by agreement.

I move amendment No. 31:

In page 35, subsection (1), line 3, to delete "shall appoint a" and substitute the following:

"shall appoint a person recruited in accordance with the Public Service Management (Recruitment and Appointments) Act 2004 to be the".

These are technical amendments providing that both the CEO and the employees are to be appointed in accordance with the Public Service Management (Recruitment and Appointments) Act 2004.

Amendment agreed to.

Amendment No. 32 is in the names of Deputies Jan O'Sullivan, Kathleen Lynch and Reilly. Amendment No. 33 is an alternative and both amendments may be discussed together by agreement.

I move amendment No. 32:

In page 36, lines 5 to 9, to delete subsection (6).

This subsection looks to gag the CEO, as it stipulates that he or she shall not question or express an opinion on the merits of any policy of the Government or a Minister, or the merits of the objectives of such a policy. This is a statutory body which is meant to protect patients and if there is something inherently wrong with the Government's policy that causes problems for the profession or is endangering patients, he or she would have a duty to speak. I do not see how we can gag the CEO and it does not seem appropriate. It does not give any impression of transparency.

Our amendment is virtually the same. I do not know of any CEO with an agenda to damage his or her organisation; CEOs are usually very protective of their organisations and this stipulation is being a bit overbearing. We must trust people placed in positions of responsibility.

This applies when the CEO comes before the Committee of Public Accounts. When the CEO of any public body comes before that committee he or she is in the role of Accounting Officer. Such people are not policy makers. There is nothing wrong with a CEO coming to this committee and giving an opinion but this simply refers to the role under the Committee of Public Accounts. Amendment No. 33 makes it clear that this relates to the accounting function, where the CEO accounts for money rather than any views on policy. The original Bill contained an error and had a more wide-ranging impact.

I am sorry to cut across the Minister.

Amendment No. 33 in my name-----

What does subsection (5) say?

It relates to the giving of evidence to the Committee on Public Accounts. It states:

The chief executive officer shall be the accountable person in relation to the accounts of the Board and shall, whenever required in writing to do so by the Committee of Dáil Éireann established under the Standing Orders of Dáil Éireann to examine and report to Dáil Éireann on the appropriation accounts and reports of the Comptroller and Auditor General, give evidence to that Committee...

That is not unreasonable. The CEO of the HSE comes here to give his views, as do the CEOs of other organisations. They are not limited in what they can say. This is a regulatory body, so the CEO will come before the Committee of Public Accounts when required to do so and speak on the accounting function.

That is a reasonable explanation. I know that neither the Minister nor the Department does the drafting of the Bill. I wonder whether that section could be made a little clearer, not in terms of the Committee of Public Accounts, but in stating that there is nothing to restrict the CEO from coming before another committee of the Oireachtas. I do not think we are disagreeing.

I am well disposed to what the Minister is talking about, but I ask her indulgence in telling us what the section will state when the amendment is incorporated.

The purpose of the board is to regulate the nursing profession.

We accept that, but what I am asking-----

If this committee invited the CEOs of the Medical Council, An Bord Altranais or the Pharmaceutical Society of Ireland to appear before it, one would find they would be forthcoming with their views on a wide range of issues to do with the regulation of the profession. However, the provisions in the Bill apply when the CEO comes before the Committee of Public Accounts.

The subsection only intimates that it relates to the Committee of Public Accounts. It does not mention the Committee of Public Accounts.

It is mentioned-----

Not in that subsection. That is the difficulty.

-----in section 28(5), on page 35.

Could we come back to this on Report Stage as we did with other amendments?

The Deputies may withdraw the amendment now and come back on Report Stage.

If they want to table an amendment on Report Stage they may do so.

We can have an opportunity to-----

I am seeking clarity. The difficulty is-----

Clarity as opposed to chaos. The Deputy will find that the CEOs of regulatory bodies are accountable to the body that appoints them, and they are very circumspect and careful. Their first responsibility is not to the line Minister. Other than passing this legislation, the Minister of the day has little function with regard to how regulatory bodies operate. People are often surprised that I hear about an inquiry into Dr. A or Dr. B by the Medical Council through the media. I do not know about these things, nor should I. That body operates totally independently of the Minister, and that is how it should be. It is the same with An Bord Altranais. I am not aware of what the board is doing on a day-to-day basis. Board members are aware of what goes on, as are the executives. In that sense, they operate totally professionally and independently, and that is how it should be.

What about the drafting of the Bill?

An Bord Altranais made many submissions on this legislation. These are available under the Freedom of Information Act and I would be happy to make them available to this committee. I am sure members of the board would be happy to come before the committee and talk about them if they were asked. There is no restriction whatever. We are not trying to gag anyone, there is no question of that. We are trying to ensure the functions are clear with regard to the responsibility of the CEO as an Accounting Officer before the Committee of Public Accounts.

On the basis of that clarification, how stands the amendment?

I will not press my amendment but I ask the Minister, rather than pressing her amendment, to wait until Report Stage so we can consider the wording in a more calm environment. There might be a need for an extra line or something similar. I ask her to indulge us.

Do I take it, therefore, that amendment No. 32 is withdrawn, with the prospect of its being resubmitted on Report Stage?

Amendment, by leave, withdrawn.

I move amendment No. 33:

In page 36, subsection (6), line 6, to delete "under this section" and substitute "under subsection (5)".

This does not prohibit Members from tabling another amendment on Report Stage if they want to have this discussion again. Our aim is to bring greater clarity to the provisions, so we should do so at this point.

Amendment agreed to.
Section 28, as amended, agreed to.
SECTION 29

I move amendment No. 34:

In page 36, subsection (1), line 11, to delete "persons to be employees" and substitute the following:

"persons recruited in accordance with the Public Service Management (Recruitment and Appointments) Act 2004 to be employees".

Amendment agreed to.
Section 29, as amended, agreed to.
SECTION 30
Question proposed: "That section 30 stand part of the Bill."

It seems ironic that in a week when France has been brought almost to a standstill by protests over the raising of the retirement age to 62, we are here talking about the imposition of retirement at 65 and the withdrawal of employment rights from people who stay on after that. The entire section relates to this. In this day and age, the freedom to continue in one's profession is important, particularly in view of the expertise that is built up over the years. This Bill allows for additional expertise to be gained. We oppose this section.

These are standard provisions across the public service. For anyone who has joined since 2004, the age limit of 65 years does not apply, as it has been increased. For anyone who joined before 2004, the age limit of 65 applies. The Minister may make an order increasing that; I recently increased the retirement age for GPs in the GMS scheme, for example. However, this is optional; people are entitled to retire at this age but they also have the option to stay. The age limit of 65 for those who joined before 2004, and 67 for those who joined after this, applies across the public service.

As the Minister can make an order changing the age limit, it is not standard practice. There are things that happen within the system that distort it.

It is a complicated area to do with people's pension entitlements and employee rights. That is why it is more appropriate, when changing the retirement age, to do so by way of regulation rather than through primary legislation. For anyone who has joined since 2004, the age limit is now 67 across the public service. We have increased the age limit and, given the increase in life expectancy, no doubt it will be much higher in the future. I do not want to speculate on that because it might scare people to think they will have to work until an age that may seem unreasonable today. In the future I have no doubt the age limit will be substantially increased. I have been following, as have most Deputies, the debate in France, where they seem to be agitating over an increase in the age limit to 62, which I regard as very young.

Question put and declared carried.
Sections 31 and 32 agreed to.
SECTION 33

I move amendment No. 35:

In page 37, line 33, to delete paragraph (a).

Amendment put and declared lost.
Section 33 agreed to.
Sections 34 to 36, inclusive, agreed to.
SECTION 37

Amendments Nos. 36 and 37 are related and alternative.

I move amendment No. 36:

In page 39, between lines 5 and 6, to insert the following subsection:

"(2) Any expenses by the Minister in the administration of this Act shall, to such extent as may be approved by the Minster of Finance, be paid out of money provided by the Oireachtas.".

What the Deputies are seeking to achieve here is found on p.13 in section 5. "Any expenses incurred by the Minister in the administration of this Act shall, to such extent as may be approved by the Minister for Finance, be paid out of moneys provided by the Oireachtas". That is the purpose of both amendments. There may have been an misunderstanding.

Amendment, by leave, withdrawn.
Amendment No. 37 not moved.
Section 37 agreed to.
SECTION 38

I move amendment No. 38:

In page 39, subsection (1), lines 24 to 26, to delete paragraph (a) and

substitute the following:

"(a) the registration of a person in the register of nurses and midwives or a division of the register of nurses and midwives,”.

Amendment agreed to.

I move amendment No. 39:

In page 39, subsection (1), lines 32 to 34, to delete paragraph (e).

Deputy Conlon brought this issue to my attention. The aim is not to charge students or candidates and therefore I am removing the charge that was to be charged to nursing students.

Amendment agreed to.
Section 38, as amended, agreed to.
SECTION 39
Deputy Mary Harney: I move amendment No. 40:
In page 40, lines 13 to 20, to delete subsection (2).
Amendment agreed to.
Section 39, as amended, agreed to.
SECTION 40

I move amendment No. 41:

In page 40, subsection (1), line 21, to delete "No" and substitute "Subject to

subsection (2), no".

This may have been dealt with already. The aim is to reconcile the subsections in line with the usual drafting practice. It is probably technical.

I asked the Parliamentary Counsel to look at this and counsel states that what is proposed here makes no change to the provisions of section 40. I shall look at it again on Report Stage, if the Deputies so wish, but that was the advice given.

I am happy with that.

Amendment, by leave, withdrawn.
Section 40 agreed to.
Sections 41 to 45, inclusive, agreed to.
SECTION 46

I move amendment No. 42:

In page 43, subsection (1), lines 25 to 28, to delete paragraphs (a) to (c) and substitute the following:

"(a) a register to be known as the register of nurses and midwives, and

(b) a candidate register.”.

While we are gazing upon ourselves here it seems the Dáil has been suspended.

Amendment agreed to.

I move amendment No. 43:

In page 43, subsection (2)(a), line 37, to delete “appropriate,” and substitute

"appropriate, and".

Amendment agreed to.

I move amendment No. 44:

In page 43, subsection (2), lines 42 to 47 and in page 44, lines 1 to 6, to delete paragraphs (c) and (d).

Amendment agreed to.
Amendments Nos. 45 and 46 not moved.

I move amendment No. 47:

In page 44, lines 22 to 33, to delete subsection (4).

Amendment agreed to.

Why was it not possible to move amendments Nos. 45 and 46?

The matter dealt with by amendment No. 44 having been agreed, amendments Nos. 45 and 46 could not be moved.

I move amendment No. 48:

In page 44, subsection (5), lines 34 and 35, to delete all words from and including "midwives," in line 34 down to and including "may" in line 35 and substitute "midwives and the candidate register may".

Amendment agreed to.
Section 46, as amended, agreed to.
SECTION 47

I move amendment No. 49:

In page 45, subsection (1), lines 36 and 37, to delete all words from and including "midwives," in line 36 down to and including "posts" in line 37 and substitute "midwives and the candidate".

Amendment agreed to.

I move amendment No. 50:

In line 46, lines 8 to 18, to delete subsection (4).

Amendment agreed to.
Amendment No. 51 not moved.
Section 47, as amended agreed to.
SECTION 48

I move amendment No. 51a:

In page 46, subsection (2), line 22, to delete "sections 49, 50, 51, 53, 54(4)

and55” and substitute “sections 50, 53, 54(4) and 55”.

This is a technical amendment to remove references to sections 49 and 51 as it is proposed to delete those sections.

Amendment agreed to.
Section 48, as amended, agreed to.
Amendments Nos. 52 and 53 not moved.
Section 49 deleted.
Section 50 agreed to.
Section 51 deleted.
Section 52 agreed to.
SECTION 53

We are considering amendment No. 54. Amendments Nos. 60, 61 and 62 are related and amendment No. 59 is an alternative.

I move amendment No. 54:

In page 48, subsection (1), line 24, after "disability" to insert the following:

"and shall declare any relevant medical disability acquired after making such an

application or after registration as the case may be".

I would like to hear the Minister's opinion on this amendment.

I will look at this on Report Stage. It is a difficult area and I would like to reflect on it. The same applies to amendments Nos. 60 to 62, inclusive.

I am happy with that.

Amendment, by leave, withdrawn.

I realise the amendment has been withdrawn but I wish to comment. The words "appropriate" and "inappropriate" are not defined in any register.

It was defined in amendment No. 60 but that amendment will fall. Amendment No. 59, in my name, mentions non-compliance with the code of professional conduct and there is a later amendment to delete "inappropriate behaviour".

Section 53 agreed to.
SECTION 54

I move amendment No. 55:

In page 48, subsection (1), lines 45 and 46, to delete all words from and

including "based" in line 45 down to and including "tribunal," in line 46 and

substitute the following:

"based on the person's qualifications, acts or omissions".

This is amendment No. 55. Deputy Lynch has moved the amendment. Is the Minister accepting it?

We are on No. 54 now.

We are on section 54, amendment No. 55. Perhaps we are going too fast.

I beg your pardon. I moved amendment No. 59 in my name.

We have not reached that yet. We are still on amendment No. 55.

I understood they were being taken together.

No, they are being discussed together but we must treat them individually.

Can I take it that I have discussed it already?

Yes. If you wish to discuss amendment No. 55 we can do so.

The purpose of this amendment is that the board could not take into account the findings of a disciplinary body either inside or outside the State. There has been much discussion, mostly with regard to doctors, of cases where someone was the subject of a disciplinary hearing in one jurisdiction and this was not communicated to another jurisdiction. This is of great concern to health Ministers throughout Europe and we have discussed it informally. The idea is here is that if the same applied to a nurse in another jurisdiction at least it should be communicated to the relevant regulatory body. If I understand the Deputy's amendment correctly, that would not happen. Is that correct?

I suppose it is to ensure that what has happened in the very recent past would not recur and that there would be an effort to communicate between different countries.

There may be a misunderstanding between us. As I understand it, this amendment would mean that An Bord Altranais could not take into account if someone had been disqualified in another jurisdiction. Perhaps that is not the intention.

That is not the intention.

We have been advised that is the case. Perhaps the Deputy could reflect on it before Report Stage.

I will come back to the Minister on this point because that is not the intention of the amendment and if that was the misunderstanding, then it was unintentional.

Amendment, by leave, withdrawn.
Section 54 agreed to.
SECTION 55

I move amendment No. 56:

In page 49, subsection (1), line 41, to delete "midwives, the candidate register and the AMP/ANP posts" and substitute "midwives and the candidate".

Amendment agreed to.

I move amendment No. 57:

In page 50, subsection (2), lines 7 and 8, to delete all words from and including "reasons" in line 7 down to and including "concerned" in line 8 and substitute "reasons therefor".

Amendment agreed to.
Section 55, as amended, agreed to.
SECTION 56

A vote has been called in the Dáil.

Perhaps we could take a minute.

The next amendment is No. 59 which deals with removing inappropriate behaviour.

No, the next is amendment No. 58. It has already been discussed with amendment No. 1.

I move amendment No. 58:

In page 50, subsection (1), lines 44 and 45, to delete all words from and including "midwives," in line 44 down to and including "posts" in line 45 and substitute "midwives and the candidate".

Amendment agreed to.
Section 56, as amended, agreed to.
SECTION 57

I move amendment No. 59:

In page 51, subsection (1), line 16, to delete paragraph (c) and substitute the following:

"(c) non-compliance with a code of professional conduct,”.

This is the deletion of inappropriate behaviour, which everyone has asked for.

Amendment agreed to.
Amendments Nos. 60 and 61 not moved.

I move amendment No. 62:

In page 51, subsection (1)(h), line 24, to delete “an irregularity” and substitute “an offence”.

I believe "irregularity" is not strong enough and that "offence" is a stronger word.

It would be good if we could conclude this section. Does the Minister wish to respond to the amendment?

The word "irregularity" is poorly defined. The Bill states "an irregularity in relation to the custody, prescription or supply of a controlled drug". "An offence" is a more appropriate term.

In light of the vote, I propose that we suspend the sitting and we will return to the amendment immediately afterwards.

Sitting suspended at 11.05 a.m. and resumed at 11.45 a.m.

Deputy Reilly had moved amendment No. 62 before the suspension.

The word "irregularity" is loose, like "inappropriate". We want to strengthen the phrasing by including the term "an offence".

That would limit the scope available in this matter. An offence would require a conviction in the courts. Many complaints are made about the mishandling of medication which accounts for 16% of adverse events in hospital. Before disciplinary proceedings could consider this as a ground for complaint, a conviction in the courts would be necessary and that is too narrow. No one has made this point to me and it would restrict the role of the board where nurses or midwives dispense medicine inappropriately, which could be dangerous for patients and should be a ground for the investigation of a complaint.

Will there be a definition of "irregularity" within the Bill?

The idea is to leave the ground as open as possible in order that if someone considers he or she could make a complaint because something irregular has happened, it could be investigated by the board. It would not be possible to define all the circumstances that could account for an irregularity. If it was to moved to an offence, a conviction in the courts would be needed; therefore, there could be a nurse or midwife who was not appropriately dispensing medication without being prosecuted and convicted. Even if that were to happen, there would be a long period in which the person concerned could still be in situ. With "irregularity" the board is free to consider a complaint from those who may work in an environment with a nurse or midwife who may consider the dispensing of medication is not being appropriately handled and make a complaint. In this way, that complaint can be investigated in the interests of patient safety.

I will withdraw the amendment suggesting the use of the word "offence", on which I accept the Minister's argument. Perhaps we could include the term "breach of protocol" as covered in the other section.

I will look at that matter before Report Stage.

Amendment, by leave, withdrawn.

Amendments Nos. 73 and 74 are related to amendment No. 63 and they will all be discussed together.

I move amendment No. 63:

In page 52, subsection (6)(a), to delete lines 17 and 18 and substitute the following:

"the Board shall decide undersection 71(1) to cancel the nurse’s or midwife’s registration under section 71(1)(f), and”.

These are drafting amendments to clarify that in a case where the board decides to cancel a nurse's or midwife's registration under section 57(6), where there is an offence and it is in the public interest to take action immediately, the decision to cancel is taken under section 71(1). Amendment No. 63 provides for the inclusion of a reference to section 71(1) in section 57(6). Amendments Nos. 73 and 74 provide for the inclusion in section 71 a new subsection (3) which clarifies there is no report following a decision made under this section to which 57(6) applies. These are technical amendments that will bring clarity to the legislation.

Amendment agreed to.
Section 57, as amended, agreed to.
Sections 58 and 59 agreed to.
SECTION 60

Amendments Nos. 64 and 65 are related and will be discussed together.

I move amendment No. 64:

In page 55, subsection (1), line 17, to delete "ex parte application” and substitute “application, which may be made ex parte,”.

This amendment relates toex parte evidence. The court is not inclined to rely on such evidence to the extent it did in the past. The amendment would ensure where there was time for the person himself or herself to present, ex parte evidence would not be relied upon entirely. I have not taken silk recently, but I rely on the advice I receive and the point is well made. I am told case law leans strongly against ex parte applications of this kind, partly for constitutional reasons, to preserve the integrity of the legislation. We suggest that, instead of providing the application would always be made ex parte, there be power to have it made ex parte but not necessarily in every case. If there was ample time to give notice without an adverse impact on public safety, the primary concern of the Bill, a court might be unhappy about granting an order of ex parte knowing it was not an emergency or that there was no immediate risk to public safety. We do not want someone to be successful in a challenge to legislation that is new.

First, anex parte application is made where something urgent occurs and it is in the interests of patient safety. For example, last Thursday night HIQA, the Health Information and Quality Authority, took an ex parte application to a court to de-register a nursing home in the midlands and the Health Service Executive had to go in and take over the running of that nursing home in the interest of patient safety. I understand most of those patients are going to other nursing homes. The same would apply here. It would have to be an urgent case to succeed. The Deputy does not appear to be concerned about that aspect of it but rather the legal technicality. I will ask the parliamentary draftsman again about the point she makes for Report Stage.

I will not press the amendment because I assume the Minister will come back to me.

Amendment, by leave, withdrawn.

I move amendment No. 65:

In page 55, between lines 36 and 37, to insert the following subsection:

"(5) The Court shall ensure that the nurse or midwife concerned is given an opportunity to make submissions in relation to the making or continuation of the order, either before (if practicable) or as soon as practicable after the order is made.".

This is-----

It is related to amendment No. 64.

It is the same argument.

The same argument applies in this amendment. If the Minister agrees to examine this I do not have a problem with that.

Is the Deputy withdrawing the amendment?

I will withdraw the amendment with leave to come back to it on Report Stage when the Minister replies.

Amendment, by leave, withdrawn.
Section 60 agreed to.
Deputy Seán Ó Feargháil resumed the Chair.
Sections 61 to 63, inclusive, agreed to.
SECTION 64

Amendment No. 66 is in the name of Deputy Reilly. Amendment No. 67 is related.

I move amendment No. 66:

In page 58, subsection (1), line 3, after "practicable" to insert "but not later than 30 days".

The rationale behind this amendment is clear. The phrase "as soon as is practical" is far too loose and in fairness to those who have complaints made against them as well as everybody else they should be informed within a specified period, and 30 days is reasonable.

I accept this amendment.

Amendment agreed to.
Amendment No. 67 not moved.
Section 64, as amended, agreed to.
Section 65 agreed to.
SECTION 66

I move amendment No. 68:

In page 59, subsection (3)(b), line 29, after “affidavit,” to insert the following:

"subject to the right of any other party to cross-examine the deponent,".

The reason for this amendment is that we believe there is a contradiction between section 66(3)(b) where it refers to evidence by affidavit and section 65(3)(c), which states that there is a right to cross-examine witnesses. Our amendment seeks the right for the other party to cross-examine the respondent. It may be simply a drafting issue but the Minister might comment on it.

Obviously, it is a legal matter. Can I take advice before Report Stage?

I am open to considering it.

I will withdraw the amendment and come back to it on Report Stage.

Amendment, by leave, withdrawn.
Section 66 agreed to.
Sections 67 and 68 agreed to.
SECTION 69

Amendment No. 69 is in the name of Deputy Reilly. Amendments Nos. 70 and 71 are related and all three amendments will be discussed together.

I move amendment No. 69:

In page 61, subsection (2)(a), line 35, to delete “and”.

The amendment seeks to remove the word "and" because I do not know what it adds to the section.

I might examine it before Report Stage. The fitness to practice is about the fitness of the nurse or the individual to carry out their practice but I will take advice and come back to the Deputy on Report Stage if that is in order.

If the Minister intends to do that, our amendment, which is related-----

Yes, I will examine them all - amendments Nos. 69, 70 and 71.

-----deals with the working environment.

Amendment, by leave, withdrawn.
Amendments Nos. 70 and 71 not moved.

We will come back to those amendments on Report Stage.

I move amendment No. 72:

In page 61, between lines 38 and 39, to insert the following subsection:

"(3) Where a registered nurse or registered midwife, is the subject of a complaint before the fitness to practice committee, requests removal of her/his name from the nurse/midwife register the Board shall remove the name accordingly, subject to the written agreement of the complainant, and the enquiry into the complaint shall be considered to be completed.".

The purpose of the amendment is self-evident.

That would weaken the fitness to practice process because one would effectively remove oneself from the register and then undermine the inquiry. The inquiry could be important for many reasons. I accept it if one does not intend to practice any more but it may well be necessary to deal appropriately with a patient's safety or an inquiry of that kind. It would undermine the whole fitness to practice process.

That is the reason we specifically include with "the written agreement of the complainant" to ensure there would be no question of-----

What happens if they apply to re-register and the fitness to practice inquiry had not concluded? They would have to be automatically re-registered. I understand the point the Deputy is making. He is trying to avoid an unnecessary inquiry if somebody is gone.

Yes, but at the same time not allow anyone escape culpability.

We could cover that. If they ever sought to re-register the board would have to re-examine the position.

I will reflect on it for Report Stage. My instinct would be to say "no" but I ask the Deputy to allow me take advice on it.

Okay. We will withdraw the amendment.

Amendment, by leave, withdrawn.
Section 69 agreed to.
Section 70 agreed to.
SECTION 71

Amendment No. 73 in the name of the Minister should have a footnote indicating that the reference to subsection (3) refers to the subsection (3) proposed to be inserted by amendment No. 74. I call the Minister to move amendment No. 73, therefore, which has already been discussed with amendment No. 63.

I move amendment No. 73:

In page 62, subsection (1), line 16, to delete "sections 57(6)(a) and 72” and substitute “subsection (3) and section 72”.

Amendment agreed to.

I move amendment No. 74:

In page 62, between lines 41 and 42, to insert the following subsection:

"(3) Where the Board wishes to make a decision undersubsection (1)(f) in a case to which section 57(6)(a) applies, the Board may do so notwithstanding that there is no report from the Fitness to Practise Committee under section 69(1).”.

Amendment agreed to.
Section 71, as amended, agreed to.
Sections 72 to 78, inclusive, agreed to.
SECTION 79

I move amendment No. 75:

In page 65, subsection (1), line 47, to delete "21 days" and substitute "42 days".

This amendment seeks to substitute 42 days for 21 days. We are all aware that midwives, by their nature and by virtue of having a saleable commodity as a skill, tend to look for work in other areas. This seeks to give them some leeway to allow them do that. It is not even-----

It is 21 days after they are sent a reminder but I may come back with 28 days. We will compromise. That is just four weeks.

I think a compromise would be after 32 days.

This is after they are sent a reminder. This is a self-financing board-----

-----and I am conscious that it needs to get in their registration fees but I will examine it and we might extend it by another week.

I am not certain that 21 days will have any major-----

It is after the reminder. It is not just 21 days. It could be 21 days after a fairly long period. I will reflect on it and come back to the Deputy.

How stands the amendment?

I will withdraw it and come back to it on Report Stage.

Amendment, by leave, withdrawn.
Section 79 agreed to.
Sections 80 to 85, inclusive, agreed to.

An amendment to section 86 in the name of Deputy Reilly has been ruled out of order.

Amendment No. 76 not moved.
Section 86 agreed to.
SECTION 87

Amendment No. 78 is related and an alternative to amendment No. 77. Therefore, they may be discussed together.

I move amendment No. 77:

In page 71, subsection (1), between lines 15 and 16, to insert the following:

"(c) The Board shall ensure that the requirements relating to the education and training of candidates for registration in the nurses and midwives register satisfy the minimum standards in any relevant directive or regulation of the European Union which relates to qualifications required by nurses and midwives to secure registration.”.

This amendment seeks to ensure the standards required to be met here match the minimum standards required to be met within the European Union. As this requirement is not specified in the Bill, this would be a useful provision.

My advice is that, given the professional qualifications regulations 2008 transposed into Irish law under EU Directive 2005/36, the amendments are unnecessary. However, I will reconsider the matter before Report Stage.

I will withdraw the amendment on that basis.

Amendment, by leave, withdrawn.
Amendment No. 78 not moved.

I move amendment No. 79:

In page 71, subsection (2)(a), line 20, to delete “Science, and” and substitute “Skills, and”.

Amendment agreed to.

I move amendment No. 80:

In page 71, subsection (2)(c), line 31, to delete “prepare” and substitute “set”.

This is a technical change to the wording to ensure consistency.

Amendment agreed to.

Amendment No. 81 was discussed with amendment No. 22.

I move amendment No. 81:

In page 72, subsection (2)(j), line 12, to delete “Science on” and substitute “Skills on”.

Amendment agreed to.
Section 87, as amended, agreed to.
Sections 88 to 90, inclusive, agreed to.
SECTION 91

I move amendment No. 82:

In page 74, lines 19 to 21, to delete subsection (2).

I am sure the debate on Report Stage will be wide-ranging. It seems the Medical Practitioners Act does not contain a similar requirement. Why is it included in this Bill and not in that Act?

It relates to the regulations. The Deputy's point is correct. Under the Medical Practitioners Act, the Minister for Finance must approve the regulations, whereas in this section we have added that a proposal must have been approved. We do not want people to draft regulations if proposals have not been accepted in the first instance. This will ensure they will not waste time in drafting regulations if we know from the outset that they will not be approved.

We have almost completed our consideration of the Bill. Would it be possible to receive a note on that matter?

I will get one for the Deputy.

Amendment, by leave, withdrawn.
Section 91 agreed to.
Sections 92 to 101, inclusive, agreed to.
SECTION 102

The amendment in the name of Deputy Reilly has been ruled out of order, as it involves a potential charge on the Exchequer.

Therefore, we cannot debate it.

Amendment No. 83 not moved.
Section 102 agreed to.
Section 103 agreed to.
Section 104 deleted.
Sections 105 to 108, inclusive, agreed to.
NEW SECTION

I move amendment No. 84:

In page 81, before section 109, to insert the following new section:

(1) Every reference to a midwife contained in any enactment, any statutory instrument or any other document shall be construed as a reference to a registered midwife.

(2) Every reference to a nurse contained in any enactment, any statutory instrument or any other document shall, unless the context otherwise requires, be construed as a reference to a registered nurse.

(3) Every reference to An Bord Altranais or Bord Altranais agus Cnáimhseachais na hÉireann contained in any enactment, any statutory instrument or any other document shall be construed as a reference to the Board.

(4) Every reference to the register of nurses contained in any enactment, any statutory instrument or any other document shall be construed as a reference to the register of nurses and midwives.".

Amendment agreed to.
Section 109 agreed to.
SCHEDULE

I move amendment No. 85:

In page 86, paragraph 21, line 6, to delete "act or matter at" and substitute "act or question at".

This is a drafting amendment to ensure consistency.

Amendment agreed to.
Schedule, as amended, agreed to.
TITLE

Amendment No. 86 was discussed with amendment No. 6.

I said I would reflect on the excellence in nursing aspect of the wording before Report Stage.

I will, therefore, deal with the matter on Report Stage.

Amendment No. 86 not moved.
Question proposed: "That the Title be the Title to the Bill."

May I may one or two further comments before we concluce Committee Stage?

We all gave our word that we would raise the issue of the position of community midwives. While we all agree that there is a need for community midwives to be indemnified, whether by way of a State indemnity scheme, a personal indemnity scheme or an indemnity scheme through a co-operative, if the service is not facilitated in some way, it will result in a removal of choice. Should it happen that there is a rare and unfortunate event during the birth of a child - such events are rare - we all agree that it would be preferable to give birth in a hospital. Nevertheless, there will always be a cohort of women who will choose to have a home birth and there must be a way of providing for this. The Bill will go a long way towards providing for a good midwifery service which will not necessarily be hospital based. Antenatal and postnatal care need not necessarily be provided in a hospital setting, although perhaps the delivery could, but the service involves far more than this. For instance, a service is provided in the majority of maternity hospitals to assist women who find it difficult to become pregnant. Many women find it a more satisfying experience to give birth at home. It would be extraordinary, should there be an unfortunate event, if all the people involved found themselves exposed in terms of liability. I would like the Minister to reflect on this and know that it is not beyond her wit or that of her officials to come up with some scheme that would allow this service to continue.

I echo what my colleague, Deputy Lynch, said. There is a demand for home births. In not providing for this there is a danger that people will be driven into dangerous waters. It is far better that it be done in an organised fashion with insured midwives in conjunction with the full team available around obstetrics. Different types of models have been put in place around the country and we would all agree that we would want to keep choice.

The second point I want to make relates to the fund for and cost of this initiative. While amendment No. 83 was ruled out of order because of financial considerations in that it could be a burden on the Exchequer, it is difficult to understand why it would be. Given that all of these people have already been remunerated from other areas, all that we were seeking was to ensure that the board would not be further disadvantaged by loss of funding which is currently available to it. That is a valid point and perhaps the Minister might reflect on that as well when she is finalising the Bill.

I am a supporter of home birth in the case of low-risk pregnancies, but clearly it must be done in the context that somebody signs the memorandum of understanding which has been agreed between the HSE and the self-employed community of midwives. We must ensure that mothers and families are protected in the event of something going wrong. If the midwife was not covered, the family would be left exposed. There is no disagreement between us. The State Claims Agency will obviously provide the indemnity, provided those concerned have signed up to the memorandum of understanding. I understand the vast majority of the self-employed midwives have done so. There is an ongoing committee, which is representative of the chief nurse in my Department, the HSE, consumer interests, nurses, etc., trying to work through some of the issues that arise.

On Deputy Reilly's point about the national council where the amendment was ruled out, we are constantly being told to merge organisations to save money. If an organisation has been subsumed into another organisation, I would hope that there would be some small saving. Deputy Reilly is suggesting that all of the money would go and that we would achieve no savings. In fact, last year the organisation did not spend all of the money allocated to it.

With respect, I was not suggesting that for half a moment.

I misunderstood Deputy Reilly, I apologise.

What I was trying to ensure was that there was no loss to them as a consequence of them coming together.

There are issues. Originally, we were going to split them between the HSE and An Bord Altranais and the council made a strong case that they should go together as an entity, and I have agreed to that. They will go together as an entity into An Bord Altranais. I would envisage, as a result, that we would be able to achieve some efficiency and other savings which, I am sure, in the current climate-----

We all would subscribe to that.

I think so. For example, in 2009, their budget was €4.285 million and they did not spend all of their money. They were carrying forward a little. Their staff costs were €897,914. The cost of the staffing this year will be approximately €800,000 and that is as a result, obviously, of there being somebody on a career break but also the reduction in public sector salaries. Clearly, we would hope that we might make some efficiency related savings as a result of the merger of the two.

Question put and agreed to.

I thank the Minister and her officials for attending today's session and for the considerable work they have put into bringing this important legislation to this point. The select committee will now adjourn until 10.30 a.m. on Thursday, 11 November when it will consider the Child Care (Amendment) Bill 2009. Bill reported with amendments.