Bernard Durkan (Kildare North, Fine Gael)

I refer to the prohibition on unregistered nurses and midwives engaging in the practice of nursing and midwifery. I thought that was a given. If I were representing a person who needed services or I received a query from a constituent in this regard, I would like to think that was the case. Will the Minister of State clarify the instances in which the prohibition was required? That would be helpful.

The approval of programmes of education and further education necessary for the purposes of registration is an excellent provision and a similar provision applies in other areas. It is important in the medical profession in general that there be ongoing training to ensure awareness among medical professionals about modern practices and developments, to make sure the highest standards of safety apply and to ensure full information is available to those working in the sector at all times. It is of major importance and I strongly support the provision as well as that relating to advanced nurse and midwife practitioner positions.

Responsibility and decisions are an important and sensitive issue in this area. I pay tribute to the nurses and midwives who over the years have given tremendous service throughout the State, well beyond the call of duty in most cases. They have rarely received the recognition they deserve over the past 70 years, particularly in remote parts of the country where they had to travel long distances in inclement conditions while in receipt of low pay. Ongoing education, upgrading of skills, awareness of new and emerging practices and the continued insistence that health and safety requirements are maintained must be ensured for the benefit of all.

Reference is made to the specification of standards of practice for registered nurses and midwives and guidance on all matters related to professional conduct and ethics. While there has been much debate about conduct and ethics generally, nurses and midwives have rarely been mentioned but they deserve to be mentioned. People depend on the professional opinion of the person with whom they are dealing and they need to have absolute confidence in that person. If he or she is adequately qualified and deserves to be registered, the public can have every confidence in the services, which is important. Unfortunately, there have been a number of cases in other branches of the health services where the reverse was the case. I am not aware of any such breach in the midwifery area but the degree to which there was a breakdown in the relationship between the patient and the practitioner at senior level is, to say the least, appalling. I do not wish to go into the details of the original cases, of which the Ceann Comhairle is also aware. When members of the public put themselves in the hands of the medical professional, at whatever level, they are vulnerable and are entirely dependent on the judgment, ethics and conduct of the person in whose hands they have placed themselves. I must say - it has often been spoken of in this House - there were many breaches in which that confidence was seriously eroded at very senior levels, which is regrettable. I hope the provision is not necessary in this instance. I know, from my own knowledge, it generally was not in any event. However, there will be variations in the degree to which individuals apply themselves to the task and devote themselves to their vocation. Nevertheless, it behoves us all to recognise that whenever we put in place in the health services a person or persons who have particular responsibilities and obligations and who, for one reason or another do not observe these or recognise the pivotal role they play, this can have a major and negative impact, not only on an individual patient but in terms of the erosion of public confidence in what is a vital service. I cannot overemphasise this.

It is interesting to note the obligation on employers to facilitate the maintenance of the professional competence of nurses and midwives, in particular by providing learning opportunities in the workplace. It is important that a work situation should not exist whereby it becomes impossible for the nurse or midwife to avail of an opportunity for ongoing improvement and training. The argument may be advanced that it is understood that such an opportunity would exist in any event but it may be given in the spirit but not in the letter of the provision. A situation could arise whereby the pressure of work would be so great that it would be impossible to avail of such opportunities for ongoing training.

It is stated that fitness to practise inquiries will generally be held in public but a decision may be made by the board to hold some or all of the inquiry in private depending on the circumstances. That is fair enough although I am not much in favour of inquiries being held in private. If an issue needs to be dealt with that may have a public interest dimension or that may have an impact on services of which the public may have to avail, where at all possible such hearings should be held in public. Much can be learned from that process. I had wished to comment on a few other matters but in the spirit of co-operation, I will conclude at this point.

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