Seán Power (Kildare South, Fianna Fail)

It has been an interesting debate. I thank all the Members for their contributions. The debate has been substantive and it is difficult to deal with all the issues raised. Nonetheless, I will attempt to respond to some of them. Members will have further opportunities to contribute when the Bill is debated on Committee Stage early next year.

I thank Deputies for their comments on the introduction of an enabling provision for nurse prescribing. I assure them that the intention is to improve services to patients. These changes are all about providing safe and convenient access to medication by patients in both acute and community settings. Prescribing by nurses will be limited by regulation and will be targeted to ensure greater accessibility to medication for patients where it will help community and acute services and where it is safe to do so. Nurses and midwives are in a well regulated profession which is an essential requirement for the changes being introduced.

The Department of Health and Children will conduct consultations with all stakeholders on the implementation of this issue before regulations are drawn up. It is not intended that all nurses will prescribe all drugs. The regulations to be drawn up will be further supported by the standards and requirements of An Bord Altranais. The Irish health care system is changing rapidly and we need to support this with proper legislation and regulation. The Irish Medicines Board Act 1995 is the legislation under which medicinal products are controlled in this country. Accordingly, this Bill, which amends the 1995 Act, is the appropriate route for introducing provisions in respect of medicinal products which will enable nurses to prescribe them as appropriate.

An Bord Altranais and the National Council for the Professional Development of Nursing and Midwifery recently published a review of nurses and midwives in the prescribing and administration of medicinal products, which was launched by the Tánaiste and Minister for Health and Children last October. This included a literature review, an examination of international experience and a needs assessment survey. It also included a collaborative project involving a small number of pilot sites. It recommended that prescriptive authority should be extended to nurses and midwives, subject to regulations. A competency framework and education requirement for nurses to prescribe was developed as part of this review which will provide a useful foundation for further developments.

As regards costs, the available evidence is that nurses and midwives are cautious prescribers. In addition, it will be possible to restrict by regulation the range and categories of medication that a nurse or midwife may be permitted to prescribe. I have listened carefully to a number of the points made by Deputies on the inclusion of an authority in the Bill to allow pharmacists and others to prescribe medicinal products. I assure the Deputies that the Department has examined carefully the issue of prescribing by other health care professions. It is considered, however, that apart from nurses and existing prescribers, the necessary regulatory regime, with adequate fitness to practise norms, is not in a position at present to permit the extension of prescribing to registered pharmacists for controlled or other drugs and medicines.

The Department is drafting legislation to provide updated fitness to practise regulations in this area. Given the importance of the pharmacist's role in the protection of public health, this area will have to be reviewed carefully. In the case of medical personnel other than emergency medical technicians, it is considered too early to introduce such an authority. It is important that appropriate structures and controls should be in place for each of the relevant health and social care professions before an authority in respect of the issue of prescriptions, particularly where controlled drugs are concerned, could be given.

The President has recently signed into law the Health and Social Care Professionals Act which provides registration and fitness to practise structures for certain health and social care professionals. However, these structures are not yet in place and it would be premature to consider giving prescribing authority to those health care professionals at this stage. A significant development has been the recent introduction of the advanced paramedic training programme and the creation of a register of appropriately trained emergency medical technicians. This register is divided into three parts, depending on the level of training as it pertains to the emergency medical technician, paramedic and advanced paramedic grades. These personnel have undergone specific training to enable them to administer a range of medications safely in accordance with strict protocols under the direction of a registered medical practitioner, depending on the drugs involved.

The regulations introduced under the Irish Medicines Board Act 1995 in August this year have provided the necessary authority for the various grades of paramedics to obtain and administer the various categories of medicinal products concerned on this basis. The circumstances are set out in the Schedules and are appropriate to each division. The authority to administer these is in accordance with clinical practice guidelines or in line with the instructions of a registered medical practitioner. Morphine injection, which is listed in the Schedule, will only be administered by an emergency medical technician, paramedic or advanced paramedic on the instruction of a registered medical practitioner. For such personnel to be in a position to administer any controlled drugs, it is necessary that they have appropriate authority under the Misuse of Drugs Act to possess such drugs lawfully. It is intended to grant a group authority under section 14 of the Misuse of Drugs Act 1977 in respect of these personnel to allow for this.

I thank Members for their thoughtful contributions to the debate. I look forward to Committee Stage, which will allow Members to make changes as they see fit and to discuss the Bill further. Ultimately, I hope we will produce legislation in this regard that will be to the benefit of us all. I thank Members again and look forward to the careful analysis of the Bill to be undertaken on Committee Stage in the near future.

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