Aengus Ó Snodaigh (Dublin South Central, Sinn Fein) | Oireachtas source

There is quite a lot in this. It was sprung on us. I have not had a chance to talk to the representatives of the nursing organisation. It is a step up. Most occupational nurses are well capable. It is the same argument in terms of midwives in hospital - they are not given the responsibility they deserve. The Minister of State is right; most occupational nurses would be well capable of making decisions based on the documentation in front of them. The problem is that I cannot see doctors being too happy about this. They have been very protective about their role in the past, although not necessarily on this issue. This might break it and it might be welcome in that way, but they have been very protective of their space, and the fact they are the ones making diagnoses.

The Minister of State is saying the deciding officer makes a judgment based on a medical diagnosis, which comes before a moral opinion, whereas nurses usually do not present medical opinions but rather they present it to a doctor who then makes the decision. Often nurses spot things much more quickly than the doctor and, in that respect, this might work better. The problem up to now is that the medical assessors seem to have been the people making the bad decisions. If one notes the level of appeals overturned, many are in the medical area. We must make sure that whatever new system comes in, we do not end up with more appeals that could be made on grounds such as only a nurse looked at an applicant's file and that the applicant wants a doctor look at it. I am not saying that would be the case but some people will try to find a reason for the appeal to stand up. I would not stand over that but that is the level at which we are.

In the past, I have encouraged people with whom I have dealt to get a consultant's letter because the consultant knows better than the GP. The occupational nurse would probably know better than the GP but that is not to say the person involved would not kick up. Has what is being proposed been broached with the Minister for Health? Is the Department of Health happy with what is being proposed because it has implications in terms of what it has been trying to encourage, namely, to allow nurses to take on a greater role and to encourage doctors to allow pharmacies to take on a greater role? That change has been very slow but this change is a major jump.

If appointed, a nurse will be taking on the role of a medical assessor. Will nurses be paid the same amount as that set aside in the past for a medical assessor in the Department, if they are doing the same work or have to write up the same type of documentation as medical assessors, or will they be taken on at the rate of pay for an occupational nurse in the health service? If it is at the higher rate, it would be welcomed by nurses and a flood of applications would be received but if is it at the lower rate, we might end up in the same position. Having regard to the level of work and the level of stress medical assessors seems to be under, we might end up in a year's time with none applying.