Bernard Durkan (Kildare North, Fine Gael)

Like other speakers, I am glad to have an opportunity to speak on this Bill. It is important and it has a regulatory function. It introduces new requirements in certain areas and replaces others. We should always welcome improvements but we are not so certain that all the provisions in this Bill are improvements. As we have come to recognise, very often the legislation we pass worsens a problem in need of remedy. I am not so certain that problems will not arise on foot of this Bill.

The explanatory memorandum states:

The purpose of the Bill is 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 will provide for a modern, efficient, transparent and accountable system for the regulation of the nursing and midwifery professions, which will satisfy the public and these professions that all nurses and midwives are appropriately qualified and competent to practice in a safe manner on an ongoing basis.

Would it not be great if this applied to the entire health service? I am sure the Ceann Comhairle agrees with me, although he cannot get up and applaud. It would be very reassuring to the public if it did apply to the health service as a whole.

The Bill allows for the protection of and provision of information to the public. It is to ensure the highest standards will apply and that there will be a right of reply and access. This is only proper but I hope the rest of the system does not strangle the intentions of the Bill and create something we did not intend to create in the first place.

The Bill, according to the explanatory memorandum, makes provision for "a regulatory body to be known as Bord Altranais or the Nursing and Midwifery Board of Ireland and an explicit statement that it performs its functions in the public interest". That is laudable and I fully support the concept. Another element of the Bill, according to the explanatory memorandum is, "The recognition of midwifery as a separate and distinct profession. Provides for clinical supervision of midwives who must have adequate indemnity insurance." I agree with that. It is important that midwifery be recognised as a separate and distinct profession and that the highest possible standards prevail.

In doing so, we must not create another tier of management and bureaucracy that could impede the way the profession operates or the service the patient expects. That could happen in a number of ways. The necessity for indemnity is increasing and obvious demands occur on a regular basis. We have witnessed numerous instances of this and I am not sure the supervisory structure is in accordance with what might be in the best interest of either the profession or the patient. How often have we heard of court cases in which it was suggested that procedures were not followed or interventions and decisions were not taken when they should have been? While the purpose of the legislation is to streamline procedures and to make sure everything works in a co-ordinated fashion, I can envisage scenarios in the future where a decision was not made because the person in charge is not fully in control or does not have the latitude required to take the decision or has thrust upon him or her additional responsibilities, which could, in turn, jeopardise their judgment and career or somebody's health.

The provision of a stronger governance and accountability structure for the board is also laudable and I fully support that. However, based on our experiences in recent years, when boards of all shapes and sizes have been formed in the health and financial sectors, the reverse has been the case. Everybody ducks and dives and runs for cover while getting away from responsibility. They do not come up with reports or answer as they should, they are not transparent or accountable and they do everything in their power to ensure their own base is covered and to hell with everybody else. This is a serious issue and many Members, including myself, have raised this previously.

The legislation concerns a vital element of the health service where a decision taken or not taken, a question answered or not answered or a person accepting or unwilling to accept responsibility in the chain of command can have widespread implications for everybody involved, including the lives of patients. While I fully support the concept of accountability and governance, I have my doubts, like many Members who have commented on this subject, about whether it will come to pass on the basis of long years of experience. I spent a number of years on a health board, as did the Ceann Comhairle. My only knowledge of this area is based on my experience on the health board and in dealing with constituents. However, as elected representatives, we need to keep this interaction in mind at all times.

See this speech in context