Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

I welcome this Bill which has been awaited for a very long time. It has been almost a permanent fixture on the list of promised legislation for years. It is ironic that the Bill appears now as the professions of nursing and midwifery in this State go through their worst experience since the 1980s due to the savage cutbacks being imposed on our health services by the Fianna Fáil and Green Party Government.

New legislation to replace the Nurses Act 1985 was recommended by the Commission on Nursing in 1998. The Government health strategy, Quality and Fairness - A Health System for You, in 2001 promised that "provisions for the statutory registration of health professionals will be strengthened and expanded". It set a target date of 2003 for new legislation on nurses. Why it has taken seven years longer than the target date to produce this legislation? That has never been explained despite the repeated efforts of Deputies on the Opposition benches to extract information on the progress in the preparation of the Bill. What does it say about Government health policy and the condition of the Department of Health and Children? The symptoms are clearly alarming and the diagnosis is not good.

The same health strategy set a target date of 2002 for new legislation to provide for clear statutory provisions on entitlement to health services. After eight years all we have got is the name of a Bill - the eligibility for health and personal social services Bill - on the list of promised legislation. The Government is still telling us that heads of the Bill have yet to be approved and it is not possible to indicate when it will be published. It is not hard to see the reason for the suppression of this commitment in the health strategy. The last thing the Government wants to do is to debate - let alone set out in legislation - the people's entitlements to health services and personal social services. To do so would undermine the basis of the wholly inequitable two-tier public-private system over which successive governments have presided, none more so than the current series of governments led by Fianna Fáil since 1997. It would also expose the gross unfairness of the health cuts currently being imposed by this Fianna Fáil and Green Party Administration.

The Nurses and Midwives Bill comes before us in the context of those cuts. In the week the Second Stage of the Bill commenced in the Dáil we had the announcement of the cutting of 52 beds in Beaumont Hospital and the axing of virtually all dental services for medical card patients. This is to be followed shortly by another Bill to undermine the medical card system, the prescription charges Bill, imposing charges for medicines on medical cardholders. The people on the front line who have to cope with the outcome of the cuts in terms of patient care are the nurses and midwives who form the core of the legislation before us. I pay tribute to them for the superb work they do in caring for people in our health services. Each of us has had our respective experiences as have our families. Thanks are due from all of us. They carry out that work despite being hampered by a fundamentally flawed system, by mismanagement at Government and HSE level, and by the current cuts.

Nurses and midwives constitute a large section of the public service workers who have been so vilified in recent times. The crass catch-cry that we have heard time after time is "Aren't they lucky to have jobs?" The answer is "No". It is not that they are lucky that they are in jobs; it is we, the people, who are lucky that every nurse is employed in the public health service because we rely on them for our hospital and community care. If they were not there, we would all know about it. In fact there are not enough of them. The Government moratorium on staffing in the public health service has seen the non-replacement of more than 1,900 nursing and midwifery posts. If the Government gets its way, the recruitment ban will continue and a further 6,000 posts in the public health services will be lost in the next three years and, as I indicated to the Taoiseach in recent days, another 3,500 acute hospital beds will be lost. That is a very serious vista.

I commend the more than 40,000 members of the Irish Nurses and Midwives Organisation who have campaigned not only against the unjust pay cuts imposed on them, but very importantly against the many cuts in services to patients over recent years. It is most often the nurses who have blown the whistle on the Health Service Executive and the Government, exposing malpractice, the reality of accident and emergency unit overcrowding, and the myriad other effects of Government cutbacks. Without their courage many of the tragic experiences we have addressed in this Chamber and that have been exposed for full public scrutiny would never have seen the light of day.

In view of this it is no surprise that the Irish Nurses and Midwives Organisation is recommending rejection of the Croke Park deal. Last winter the INMO and the other health unions went the extra mile in the pre-budget talks with the Government. They were and are prepared to help implement far-reaching changes in working practices to enhance the public health services. However, that deal was rejected by Government when it staged its mock backbench revolt. It baffles me why, in those circumstances, the leaders of the public service unions returned to the talks and accepted such a fundamentally flawed deal as that now before the membership for balloting.

This is the very serious backdrop against which we debate this Bill. However, it is more than a backdrop. Such is the attack on our public health services that the professions of nursing and midwifery are being undermined. With its anti-public service agenda and its drive to privatisation this Government has damaged nursing as a profession, as a calling to provide care on the basis of need and as a service to all of us, the people. We should take the opportunity of this Bill to reassert the role of nursing as a public service. I commend the stated purpose of the Bill to enhance the protection of the public in its dealings with nurses and midwives and to ensure the integrity of the practice of nursing and midwifery. It aims to provide for a modern, efficient, transparent and accountable system for the regulation of nursing and midwifery, ensuring that all nurses and midwives are appropriately qualified and competent to practise in a safe manner and on an ongoing basis.

I welcome the provisions for the establishment of Bord Altranais agus Cnáimhseachais na hÉireann, the Nursing and Midwifery Board of Ireland. The composition of the new board as set out in the Bill seems representative and I welcome some of the more open procedures for the appointment of members, including the election of eight nurses or midwives by nurses and midwives themselves.

The enhanced recognition of midwifery is welcome. However, concerns have been raised already that the representation of midwifery on the new board is not sufficient and about the legal requirement for indemnity for midwives. I ask the Minister to note this. There is concern that the Bill may not go far enough in recognising midwifery as a distinct profession. I recognise it and affirm that in the House. The requirements for proper qualification, registration, complaints procedures and sanctions where necessary are appropriate. These are detailed sections and will require careful scrutiny on Committee Stage.

Section 86 outlines the duties of the Health Service Executive to facilitate education and training of student nurses and midwives and the Bill will provide the legal basis for this. The big question is whether the HSE will be able to fulfil this mandate in the context of major cuts to public health services. Nurse training places have been cut back in recent years and training and education have been undermined as a result. Similarly, will the HSE, as an employer, be able to fulfil the obligation under Section 92 to facilitate the maintenance of professional competence of registered nurses and midwives pursuant to a professional competence scheme? The Bill also states that the employer "may" facilitate this by providing learning opportunities in the workplace. Again, how realistic is this under the current regime and its attacks on our health services? The word "may", as often referred to in the House regarding other legislation is, potentially, a get-out clause and a means of ignoring its responsibilities on the part of the HSE. That needs to be addressed.

As the INMO has stated in regard to the Bill, we must ensure that the necessary infrastructure for nurse and midwife undergraduate and post-graduate education is in place and maintained.

All those points being made, I commend the Bill and look forward to its enactment. Sinn Féin Members will support its passage through all Stages.

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