Jan O'Sullivan (Limerick East, Labour)

The Labour Party broadly welcomes the introduction of this legislation. It has been a long time coming, recommended by the Commission on Nursing in 1998. The Bill has also been welcomed by nurses, midwives and their representative bodies. The Labour Party, accordingly, does not intend to oppose the Bill on Second Stage. However, it will raise some concerns and table amendments on Committee Stage which it hopes the Minister will consider seriously.

All parties want to ensure a proper regulatory system for the nursing and midwifery professions which would be in line with the Medical Practitioners Acts and the Health and Social Care Professions Act. As Deputy James Reilly said, there are some subtle differences between this legislation and these Acts. There is a heavy handed control aspect of it which we will seek to address. I tabled a question to the Minister answered on 11 May in respect of amendments to the Medical Practitioners Act and I call on the Minister to reply in respect of this issue. I was given to understand the Irish Medical Council sought amendments to that Act. In her reply, the Minister stated two minor technical amendments would be included in legislation later this year. The Minister went on to note that the Medical Council held certain concerns. Will the Minister address this issue? Understandably, the representatives of nurses are keen that if changes are being made to the Medical Practitioners Act later this year, we should ensure the Nurses and Midwives Bill is in line with that Act. Will the Minister clarify the changes to be made?

I refer to the issue raised by Deputy Reilly towards the end of his contribution, that is, the fact that there is no provision whereby nurses and midwives can advise health service providers, including the HSE, when they hold concerns about standards and the safety of patients in the workplace. Will the Minister consider empowering the board to provide for this on the basis of information coming from practising nurses and midwives? This is in the context of the current climate in which nurses and midwives are working with cutbacks and increasing number of patients for which individual nurses and midwives must care.

Yesterday, I spoke on the telephone to a man who informed me he was in the accident and emergency department of Beaumont Hospital along with a large number of others. He had to wait 15 hours for treatment and only four nurses were available to look after all the patients going through the department during what was a very busy night in that hospital. That is simply one example, but we all know of nurses who are literally rushed off their feet. There has been a great increase in the amount of paperwork and forms they must fill out and complete as well. A good deal of bureaucracy is attached to the work of a nurse now.

Many nurses have indicated to me that they are, fundamentally, a caring profession and would rather have time to listen to patients, to sit down beside them and to hear their concerns. However, it is proving more and more difficult for nurses to do so in the current climate. I raise the issue in the context of nurses being able to bring concerns to the attention of the providers of health services. In many cases, they are not listened to. I note the concerns in the context of the reconfiguration in my region whereby a small cohort of clinical leaders now make all the decisions. It appears other health professionals do not have a say, including general practitioners as well as nurses and public representatives who represent patients in the system. The general point is important in the context of this legislation, although I realise we are dealing specifically with the regulation and standards with regard to nursing and midwifery.

That there has been no whistleblower legislation is another issue. I understand the Government's approach is to introduce it in various bits and pieces of legislation. However, the Labour Party and I believe there should be overall whistleblower legislation, which would protect people in the service who raise certain issues. I have in mind nurses from Our Lady of Lourdes Hospital who were the first to raise concerns in respect of Dr. Michael Neary among other concerns with regard to that hospital. I refer also to the nurse who led and continued to lead the people who have concerns in respect of Mr. Michael Shine. Nurses are in a unique position to indicate where there are issue of concern that may directly affect the safety and well-being of patients. I believe strongly that relevant provisions should be in the Bill and I call on the Minister to consider this.

I refer to several other matters I wish to raise. I note the Minister stated more than 200 individuals, organisations and representative groups made submissions. Many voices have been included and there is a good deal of interest in the area. I welcome that midwifery is being recognised as a separate profession. This was sought and, as the Minister stated in her contribution, a direct entry midwifery undergraduate programme commenced in September 2006. It is a separate and distinct profession, which has the potential to be developed a good deal. AIMS, the Association for Improvement in the Maternity Services, recently called for more midwifery-led obstetric and maternity opportunities, which many women want. They prefer their babies to be delivered by midwives rather than obstetricians. That issue must be addressed as well. In her response in respect of maternity services and specifically the report of the Dublin maternity hospitals, the Minister indicated she is disposed to the idea but this matter must be addressed as well.

I refer to an issue raised by Deputy Reilly, that is, the fact that there is only provision for one midwife on the board, although there is provision for a separate midwifery committee. In the make-up of the board, there are nursing representatives from general, children's, psychiatric, intellectual disability and public health nursing and one midwife. Considering that fitness to practise issues will arise and form a considerable part of the work of the board, the presence of only one midwife makes it a very onerous job for that person to be able to deal with all the issues that affect midwives and I call on the Minister to examine this provision. Midwifery is acknowledged in the Title of the Bill as a separate profession but there is only provision for one midwife on the board, while there are representatives of a variety of areas of nursing on the board. It appears to be rather imbalanced and I call on the Minister to address this imbalance.

As Deputy Reilly noted, the Irish Nurses and Midwives Organisation has concerns about the membership of the board, its size and the fact that only eight members are elected while some 15 are appointed by the Minister. I realise this has happened with other legislation and that the Minister may reply that while she appoints the members of the board she has no role in choosing them because they represent various groups and organisations and so on. However, ultimately, it is the Minster who appoints these members and the president. It appears too politically ordered and everyone involved would prefer a greater sense of democracy and the presence of other voices in terms of the make-up of the board.

I refer to other matters which the Minister raised in her contribution. Deputy Reilly remarked on the matter of registration, fees and costs. It appears there is little clarity about how the money to run the board will be raised and where it will come from. If it is meant to be largely funded from fees paid by nurses and midwives I would have concerns, especially with regard to student nurses because they are included in the register. There is a list which contains the names and details of all individuals who are pursuing education and training. However, I am referring to students. I am unsure what fees they will be expected to pay and I call on the Minister to clarify this because, basically, students do not have the money to pay large fees for anything. There is also a concern in respect of students and whether they will be held responsible under the fitness to practise areas. Typically, a student is under the supervision of a qualified person at all times and this is the definition of a student experience. It is unclear how much responsibility students have if they make mistakes. If someone hauls them before the fitness to practise committee, to what extent is a student held responsible if he or she is on the register?

I also met with representatives of the Irish Nurses and Midwives Organisation who are concerned that people are to be added to the advanced practitioners register on the basis of post rather than qualifications. In other words, a nurse who does not have an advanced nurse practitioner's post, even though he or she may have previously worked in such a post and has the relevant qualifications, will not be included on the register. I understand the same does not apply in regard to registers of other professions.

In regard to the issue of fitness to practise, the Bill offers several ways in which complaints can be addressed. The preliminary proceedings committee will sift through complaints and decide which should be sent forward for investigation. This is a good proposal because it will mean, for example, that mediation can be proposed. We all like to avoid the confrontational approach if possible. I assume that part of the process will not be held in public. There is a recommendation that fitness to practise procedures be held in public but there is also provision for all or part of an inquiry to be conducted in private. It is important that complaints may be dealt with in private in certain circumstances. Public interest and patient safety are the primary concern, but where a person's good name is at stake, it may be appropriate to hold hearings in private.

Regarding education and training, it is important that the standards and so on are clearly set out. Unfortunately, many nurses currently in training are being trained for export because there are no jobs for them. Bright, well trained young nurses coming out of university have no option but to go abroad to work. It is striking that we are discussing education, post-registration training and so on, but the reality is there are no jobs. The proposal that premises where clinical training is provided should be inspected by the board is welcome. However, if a nurse is training in an overcrowded accident and emergency unit or an overcrowded ward, he or she will have legitimate concerns but those concerns are outside the control of the board. How may such concerns be addressed? I already raised the question of nurses and midwives being able to bring such issues to the attention of the Health Service Executive or the private health service provider.

The area of patient advocacy is important. Patients are often more likely to relate their concerns to nurses than to anybody else they encounter in hospital. There must be some mechanism whereby those concerns can be conveyed to the people running the hospital. There are all types of informal complaints procedures but much of the time the patient simply wants to bring the issue to somebody's attention so that it can be corrected for future patients. Patients do not necessarily wish to engage in an adversarial complaints system. A mechanism should be found to address many of these issues positively, and there is a role for the board in this regard.

Regarding the dissolution of the National Council for the Professional Development of Nursing and Midwifery, will the Minister clarify what additional staff will be needed and how this will operate in terms of funding. I understand the Minister for Finance is involved. Will staff from the Department of Health and Children be transferred? A recent newspaper article highlighted a report by the Department of Finance suggesting that some staff in the Department of Health and Children have nothing to do-----

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