Dr. Maura Pidgeon:

That is no problem. Perhaps I will respond first to Senator Crown's questions as we await the return of other members. I thank the Senator for his questions. The rationale for the increase in the annual retention fee has been well documented. The fee was increased in two consecutive years due to the low cost base on which the organisation had been operating for some time. In 2013, the board proposed to increase the fee to €140 in 2014. Given the circumstances, however, it decided to leave the fee at €100, with a view to increasing it in 2014 for the 2015 annual retention process. The reason for the fee increase was simply the cost of implementing in full the new legislation and the subsequent need to modernise the organisation. This involved the development and replacement of old information and communications technology, not to a highly sophisticated level but to a level that would allow a modern organisation to conduct its business. The fee was primarily due to the cost of implementing the new legislation, which amounted to more than €8 million in a four-year period.

The cost as a result of the new legislation was in excess of €8 million over that period of time. The issue of how the organisation and regulatory body is viewed by those we register is of concern. We are mindful of it and one of our objectives, as we work our way through the implementation of the new legislation and conduct our business, is to create greater awareness of what it is to be regulated and how regulation can support individual nurses in the advancement of their practice on a daily basis.

The sole of objective of the regulatory body is to protect and safeguard the public from people referring to themselves as nurses who may not have met the competencies or who have impaired standards. We do that through the setting of standards for education, continual professional guidance and the code of professional conduct. In that respect, the public interest is addressed through the setting of standards for nurses and midwives.

In respect of value for money and the costs of running the organisation, the nursing board, under the new legislation, comes under the remit of the Comptroller and Auditor General. The board's accounts have been audited by it for 2012 and 2013 and the process has not made any adverse findings to include in the report of the accounts of the public services that were laid before the Houses of the Oireachtas. The accounts for 2014 have recently been completed and no matters of substance emerged during the course of this audit.

With respect to the costs of replacing staff who have left the organisation, the overall cost would be in the region of €500,000. These costs had been budgeted for in the business case for the original fee of €150.

With regard to travel, as the Senator would be aware, international work is a routine and normal part of the work of the regulator, in particular regulators of health professionals which is very much a global activity. The recognition and appreciation of the developments of nursing and midwifery in Ireland is recognised across the world and in order to sustain that development and apply evidence-based practice to our regulation, it is important the board continue that international work. The international work and participation in international forums and networks is no different to that of my predecessors over the years. I am contractually obliged to carry out this work. As I said in regard to auditing, all of the travel costs have been audited and are in compliance with Department policy.

With respect to the tombstone approach, there are three elements and I appreciate that nurses and midwives do not always see the middle element of regulation. First is registration and second is maintaining nurses' competence while on the register. We have continued to do that during the past four years through the launch of a new code of professional conduct and ethical practice. We recently approved a new scope of professional practice for nurses and midwives which will enable and facilitate greater latitude in the work nurses and midwives can do. We have revised the practice standards for midwives. Our revision to the undergraduate standards and requirements for the education of nurses and midwives will go to the board for approval in the autumn.

We are, in conjunction with the HSE, revising our guidelines for the management of medications. A multidisciplinary forum is revising the policy and standards on nurse prescribing. We address the professional development of nurses and midwives. On registration and renewal, I will defer to Ms Byrne who can provide some of the detail on that and can explain why it is more complex.