Bobby Aylward (Carlow-Kilkenny, Fianna Fail)

I thank my colleague, Deputy Kelly, for sharing time. I am pleased to have the opportunity to speak in support of and to praise the Bill before us today on Second Stage. At the outset, I extend my congratulations to the Minister, Deputy Mary Harney, for bringing the Bill to fruition and for producing a pragmatic and comprehensive piece of draft legislation.

The Bill has been in gestation for some time and I welcome it without hesitation. I am also conscious that the Bill was not formulated until the Minister and her Department had engaged in an extensive public consultation process since 2007, not least with the various interested parties and the obvious stakeholders who will be affected by its provisions. I understand the response and the input made to that particular exercise was considered, thorough and enlightened. Now that this essential and valuable process has been completed and the various concerns and proposals have been heard clearly by the Minister, we have before us a Bill which reflects the views and the aspirations of the public and the noble professions of both nursing and midwifery.

The existing legislation which governs these professions at present is barely adequate and is clearly well and truly out of date. It is 25 years old and, in many respects, it has become archaic and outdated. It no longer meets the exacting requirements of the modern and dynamic professions it addresses, both of which have evolved radically since 1985. I welcome the Bill as timely and one that addresses the needs of the public and the two professions in question.

First, I salute the nursing profession and the profession of midwifery and all those individuals who work so hard and tirelessly for all of us. Many of us would not be here today, literally, were it not for the care and skill nurses and midwives profess. Irish nurses and midwives are recognised the world over for their finely-honed skills and unique dedication as expert care-givers. Any of us who have had the privilege of being treated by nurses know that they truly excel in their professionalism, sincerity and kindness. We are most fortunate to have such a fine, genuine and committed workforce which is generous with its compassion and its humanity. I thank all the nurses and midwives who work so selflessly and tirelessly everywhere around the country. They are a magnificent group.

At the end of 2009, there were more than 89,500 nurses and midwives registered with An Bord Altranais. A total of 43,264 of those individuals were working in the public health service and approximately 9,000 nurses and midwives were employed in the private sector. Like any other profession on whose services the public relies, nursing and midwifery needs to be properly regulated in a robust and transparent manner. The halcyon days of self-regulation are over. We have entered a new and welcome era where the public demands a framework of regulation that ensures the safety, quality and efficacy of the service being delivered stands up to rigorous, ongoing scrutiny and the highest possible standards.

The central feature of the Bill is the protection of the public interest. That imperative is clearly enshrined in the Bill. Every aspect of the Bill is predicated on the public interest and the provision of a top-quality health service to each and every individual. Public confidence in, and respect for, the professions of nursing and midwifery are paramount. The quality and efficient delivery of an effective health service is probably one of the single most important objectives which the Government can achieve. I am pleased to say the Bill represents yet another significant milestone in achieving that aim.

The health service is critical to all our needs and the calibre of all those involved in the delivery of that service is second to none. However, the technical nature of the professions engaged in that service is complex, sophisticated and is one which is changing and developing constantly. Advances in medical, surgical and obstetric practice are immense and it is necessary to ensure that all staff who work in the health service are well versed and well trained in the execution of the service. Optimum performance and optimum results are what the service is about and that is, rightly, what the public, as the customer, expects.

The health service is perhaps the only service with which everyone has interface at some time in their lives. At such a time, people are brittle and vulnerable. We must recognise that patient care and safety are the fundamental elements in the health service and anything we do in terms of regulation and internal governance must acknowledge that fact and seek to promote and uphold those basic principles. That is why we must guarantee that the professions with which they relate are regulated properly, that the necessary qualifications are in place, that clinical and technical training is provided on a regular, ongoing basis, and that there is a fair, adequate and transparent complaints procedure is available if the need arises. That is what inspires public confidence in this vital system. It is important to have secure safeguards, for the protection of the patient, the nurse and the midwife. All other professions within the medical arena are now very well-regulated and there is no reason why nurses and midwives should not be subject to similar-safeguards and strictures. This Bill is consistent with the stringent regulatory regime which we have adopted for other-professionals in the health sector including the medical practitioners, the health and social care professionals and the pharmacists and I believe: it creates a welcome level of uniformity in the regulation of all healthcare professionals.

For the first time a separate distinction is made between the nursing profession and that of the midwife. This is a welcome departure and recognises that the training and the discipline of midwifery are specific and quite different in many practical aspects to that of nursing. I believe that the Nurses and Midwives Bill will greatly improve the existing situation and enhance the statutory framework within which these professions are governed and regulated. We have seen very substantial progress in nursing and midwife practice since 1985 and there has been an enormous leap forward in the area of training and development. Of course, there is ever-increasing emphasis on the issue of accountability and the rights of the patient. There is a clear need for nurses and midwives to keep abreast of all the new developments and naturally, patients must be kept fully informed. As we are all aware the expectations of the public have increased very significantly in the past 25 years, and rightly so. Both the Government and the various stakeholders were acutely aware that the time had come to modernise the framework of regulation in which nurses and midwives operate. We have to structure and adapt our framework to ensure it is fit for purpose, contemporary and that it properly accommodates those essential features such as the safety of the patient, the absolute assurance of standards, sound governance, accountability, openness, and of course, justice and fairness when it comes to matters of complaint and procedures for discipline. An appropriate balance has to be struck between self-regulation and public accountability which will reflect the changes in attitude over that past 25 years and I believe that this Bill takes into account those changes and it adjusts the legislative framework accordingly.

The Bill will undoubtedly enhance the protection of the public in all its interactions with nurses and midwives. The creation of a competency assurance scheme emphasises the clear and definite focus of this legislation. This will ensure that the integrity of those in professional practice is maintained, high standards of professional conduct are observed and that all nurses and midwives have the relevant qualifications and are competent to carry out their work in a safe and effective manner - and that they can demonstrate that profession competence. The Bill will ensure that the necessary education and professional training and development facilities are provided, and that nurses and midwives will be able to avail of additional training and up-skilling throughout the course of their careers in the health service by providing suitable education opportunities in the workplace.

I welcome the establishment of the new nursing and midwifery board, which will have as its core and overriding objective the protection of the public interest at all times. I also welcome the fact that the representation on the board will include a majority, not from the nursing and midwifery professions, but from other areas within the health service, from education and from the public. A similar composition will apply to the fitness to practise committee and the new preliminary proceedings committee. I am pleased to note that the Bill will introduce a new, streamlined and more flexible fitness to practise procedure that will include a measure to screen complaints and which can refer complaints to the fitness to practise committee or to other procedures if the complaints are not appropriate for the board's fitness to practise procedures. The fitness to practise committee will certainly have teeth: it will have similar powers to those of a High Court judge and, for example, it may compel witnesses to attend and be examined under oath,and the production of documents.

I note that in future, fitness to practise enquiries will be held in public unless, on application, the particular circumstances of individual cases dictate that they be held in private. At present, all these hearings are held in private behind closed doors so they are lacking in transparency and do not lend themselves to the same degree of confidence that a public inquiry does. I believe that this departure will be positive and will be embraced both by the public and by those who may find themselves involved in such proceedings.

I gather the Bill has been broadly welcomed by the nurses and the midwives alike. In view of increased public awareness and consciousness in all matters to do with health and the overarching need to ensure that the highest possible standard of service is delivered and maintained, I am confident that it will achieve its stated aims. It will serve to augment widespread confidence and respect among all its many stakeholders and it will create an appropriate and enlightened response to the challenging needs of our times

I am happy to support this Bill without any reservation.

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