Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

We will see. While Sinn Féin will not oppose this Bill, the way in which it has been presented by the Government is most unsatisfactory. It is complex legislation which amends four separate Acts of the Oireachtas and a considerable number of regulations. With limited time and resources, it is impossible for a small Opposition party to deal comprehensively with all aspects of such a Bill. The difficulty is compounded by the introduction of significant amendments in the Seanad.

I cast no aspersions on those within the Department of Health and Children who work on legislation but the question arises as to whether they are adequately resourced and equipped to support the legislative role of the Tánaiste and Minister for Health and Children and her Department. On the Order of Business, I raised the Government's failure to produce a Bill to provide for repayments to those on whom nursing home charges were illegally imposed. The Tánaiste and Minister for Health and Children again referred to the extreme complexity of the legislation and has apparently pushed back the date of publication well into 2006. The Bill in question was promised for September 2005. It was to be published before the beginning of the forthcoming session at the end of January 2006.

It is more than a year since the Tánaiste and Minister for Health and Children undertook to repay those who were illegally charged and to provide for this repayment in legislation. If I recall correctly, these people were led to believe that everything would be in place by April 2005. It will clearly be beyond April 2006 before we have a legislative basis for repayments. These issues are connected, although we are not addressing the repayment of illegal nursing home charges today. It is unacceptable.

Something has clearly gone awry to result in the continued backlog and ensuing rush to introduce legislation. It is very difficult for everyone to deal with everything this entails. It is even more alarming in light of the nursing home scandal itself in which flawed legislation was allowed to stand and was not rectified. As a result, massive costs will be incurred by the State.

The Irish Medicines Board (Miscellaneous Provisions) Bill 2005 has undergone a metamorphosis in the Seanad and is now a different creature to that initiated in June 2005. Section 26, as inserted by amendment in the Seanad, is now the most significant section of the Bill. This section was not part of the original Bill but is the section that will be repeatedly referred to in future. It is the important and long-overdue provision to allow certain nurses to prescribe medicines. I welcome this provision.

It is vital that nurses have these powers and responsibilities. The fact that nurses have not been allowed to prescribe drugs has been a considerable disadvantage in our health service. However, I am very concerned by the wording of section 26. As I understand it, the section does not include midwives, although the Minister of State will correct me if I am mistaken. We need clarification regarding the categories of nurses who will be given these new responsibilities. The anomaly thrown up by the exclusion of midwives, if this is the case, must be rectified.

The review of nurses and midwives in the prescribing and administration of medicinal products was published in June 2005 and made a number of recommendations. The review recommended that "an explicit legislative basis be provided for the supply and administration of medicinal products using medication protocols by nurses and midwives in hospital and community settings". This recommendation is very clear and includes midwives. The report was the result of very intensive research and wide consultation. The report's third recommendation was that:

Nurses and midwives should be enabled to supply and administer over-the-counter medications to patients and clients in accordance with their competence and within their scope of practice and supported by medication protocols where appropriate.

The review's fourth recommendation was that:

Prescriptive authority should be extended to nurses and midwives, subject to regulations under the relevant legislation by the Minister for Health and Children and regulation by An Bord Altranais.

The review's fifth recommendation was that:

An Bord Altranais and the National Council for the Professional Development of Nursing and Midwifery should establish a Project Implementation Team to work in consultation with key stakeholders to facilitate the implementation of these recommendations and actions.

Will the Minister of State indicate the extent to which these recommendations are being implemented by this Bill, if further legislation is required and what other steps need to taken to implement the report's recommendations fully?

We have been awaiting the nurses Bill for years. It is long overdue and I would have thought that such a Bill would have been the appropriate vehicle for providing for nurse prescriptions.

The primary consideration in this must be the safety of patients. We must ensure that those with responsibility for prescribing are subject to the most stringent controls and act responsibly at all times. We must also ensure that medicines policy is implemented and that medicines are used in the best interests of the overall health service. I have raised the issue of the exorbitant cost of medicines on many occasions, the profiteering of pharmaceutical companies and the need for preference to be given to generic drugs. The State could make significant savings and divert much funding currently spent on overpriced medicines. The pharmaceutical industry is very profitable and is one of the key sectors of the economy here. However, there are also many vested interests in this area, including the pharmaceutical companies and even pharmacists and GPs. These groups are very interested in the State's policies on medicines, but our consideration must be public health above all.

I have dealt with only a couple of key aspects that arise out of this Bill. It is very complex legislation covering a plethora of areas and I hope we have a chance to return to these areas at later stages of the Bill. I welcome the Bill and I wish it a fair wind, as I do to the Minister of State, Deputy O'Malley, as he leaves the House.

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