Áine Brady (Kildare North, Fianna Fail)

I thank Deputy Durkan. I am glad to note that there seems to be a broad welcome for the Bill and agreement that we should update and enhance the regulatory and governance framework for nurses and midwives. I will briefly address some of the significant issues raised:

First, I assure the House that the board will have a minimum of two midwife members One of these will be elected by the professions and one will be appointed from the third-level education sector. In addition, there is a potential for a further two board members to be midwives. The elected member who is engaged in the education of nurses and midwives could be a midwife and a director of nursing or midwifery member could also be a midwife. I am committed to a non-nursing midwifery majority on the board and I am sure my colleagues agree with this. It is also vital that the composition of Bord Altranais agus Cnáimhseachais reflects the wide ranges of skills both of nurses and midwives and of other stakeholders including the Medical Council, HIQA, the HSE and the education sector. At the same time, the board must reflect the principles of good governance which I believe are better served through a reduction in the size of board memberships.

A number of the speakers addressed the issue of the proposed reduced membership of the board and the ratio of nurse-midwife board members to the number of nurses or midwives on each division of the register. Board size is not related to a ratio of the number of members from the professions. What is required is a board membership which will provide for good governance.

As the Minister, Deputy Mary Harney, stated in the House when she proposed this Bill, a reduction in the size of the board will not impact negatively on the performance of its functions, many of which will be carried out by committees. Non-board members can be members of a committee and this will allow for committees to include individuals with relevant expertise and experience to undertake the functions assigned to them. Some Deputies expressed concern that the Minister for Health and Children can appoint the president of the board and that it is not essential that the president be a nurse or midwife. I would like to clarify and emphasise that this only applies in the case of the person to be the first president of the board.

There is no intention to compromise the independence of the board. Rather, the intention here is to allow the Minister to select a member of the board who is considered to have the necessary knowledge and experience to lead the new board in its first years. I would emphasise that the Bill provides that all subsequent board presidents must be elected by the board from its nurse or midwife membership. This is provided for in the Schedule, paragraph 13.

I have already addressed the issue of the midwife membership of the board. I should now like to deal with the composition of the midwives' committee where Deputies are concerned about the size of the committee and its ability to adequately represent all areas of midwifery practice. This committee will consist of a minimum of five members,and it will be open to the board to select its members. There is no maximummembership laid down. At least three members will be registered midwives - one of whom must be one of the midwife members of the board. As committee members do not have to be board members, there will be flexibility to ensure that committees such as the midwives' committee, as well as the preliminary proceedings committee and the fitness to practise committee have adequate knowledge and experience to perform their functions.

Some Deputies asked for clarification on the registration of advanced practice posts. Advanced practitioner posts are developed in response to patient needs and healthcare service requirements and have been shown to be very effective in certain situations. Before the creation of a post the HSE or a service provider must determine the service need and put in place appropriate structures and procedures for the post to be registered. The competencies and skills required for the advanced midwife practitioner or advanced nurse practitioner differ, depending on the specific requirements of each advanced practise post.

To guarantee the required structures and governance, skills and competencies, registration as an advanced nurse practitioner or an advanced midwife practitioner is dependent on employment or an offer of employment in a registered advanced practice post. This ensures that the public is protected by guaranteeing that advanced nurse practitioners and advanced midwife practitioners are only those who meet the standards and requirements for advanced practice and have the skills and competencies necessary for the post they are working in, and that the required structures and governance procedures are in place to enable them to carry out their duties in that post.

The Bill will not limit the development of the professions or the expansion of advanced practise unnecessarily. It will, however, ensure that service need for advanced practice is clearly defined. Any service provider, including the HSE, can identify the service need and can apply to have an advanced practise post registered, and it will be so registered if it meets the standards and criteria set by the board.

Deputies Reilly and Neville made reference to the recommendation contained in the report of the Commission on Patient Safety and Quality Assurance in relation to fitness to practise provisions and asked why we did not opt for the separation of fitness to practise from the regulatory function. This was, in fact, answered in the regulatory impact analysis as follows:

...the detail of how it would operate is not clear and it will be the work of the sub-group to examine and make proposals as to how this might be achieved.

As it may be some time before the implementation steering group is in a position to make recommendations it is proposed that the Nurses and Midwives Bill should proceed in line with the Medical Practitioners Act 2007 and can be amended if necessary in the future like for all other regulated health professions.

As the Minister has regularly stated, this legislation is aligned with the Medical Practitioners Act 2007 and has been examined in detail and adjusted where necessary. The Minister has taken into consideration the experiences of other regulatory bodies and the legislation pertaining to them.

Deputies have raised the issue of possible amendments to the Medical Practitioners Act and the impact these would have on the legislation currently before the Houses. I assure the Deputies that proposed amendments to the Medical Practitioners Act were examined with regard to the Nurses and Midwives Bill to ensure that the relevant issues were addressed.

Several Deputies suggested that the board should be assigned a role as a conduit for the concerns of nurses and midwives regarding the health services. The board is a regulatory body for nurses and midwives; however, it can refer matters to other bodies, such as the HSE's complaints procedure, HIQA, or other regulatory bodies. As the Deputies are aware, HIQA is responsible for setting standards in the public health services and for monitoring compliance with those standards.

These issues and others will be discussed in greater detail during the forthcoming Committee Stage and in the passage of the Bill through its remaining Stages in the Oireachtas. I welcome this debate. The views articulated reflect the widespread interest in this Bill, in the modern and robust regulation of nursing and midwifery, and in ensuring full public confidence in these professions.

See this speech in context