Mary Harney (Dublin Mid West, Independent)
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I move: "That the Bill be now read a Second Time."

Nursing and midwifery are the cornerstones of our health service and Irish nurses and midwives have long enjoyed a fine reputation both at home and overseas. The provisions of the Bill before this House are designed to further enhance this reputation by supporting these professions and the dedicated individuals who work in them. While I acknowledge that this legislation proposes a wide range of changes, nurses and midwives have shown great willingness and ability to progress and change their roles to meet the changing needs of patients and clients. They command enormous respect from the public and are critical to our health service. I am confident they will embrace and support the changes proposed in this Bill.

The delivery of a modern health service is a complex activity. Since becoming Minister for Health and Children, I have emphasised the need to place the safety of the public high on the health agenda. This Bill is a key component in the construction of a system of governance and accountability for the health services which has the public interest and patient safety as the focal point.

The Nurses Act 1985 provides the current statutory framework for the regulation of the professions of nursing and midwifery. It needs to be revised to reflect the fact that the provision of health services both within Ireland and internationally has developed considerably since then. Nurses and midwives have been at the centre of these developments. Since the implementation of the Commission on Nursing report in 1998, we have seen enormous progress in the education and training of nurses and midwives both at graduate and undergraduate level and significant development in their role and career structures across specialist clinical areas. We have also seen an increased emphasis on the importance of the rights of patients and the accountability demanded of all of our health professionals.

The era of self-regulation provided for in the 1985 Act has passed and a new governance framework is needed to reflect this. We need a legislative basis to ensure that the regulatory body for nurses and midwives discharges its functions in an accountable manner which underpins the protection of the public in its dealings with nurses and midwives, by enhancing the high standards for professional education and training and introducing ongoing competency.

As Minister for Health and Children, I am committed to the introduction of new primary legislation for the regulation of health care professionals. The provisions of the Nurses and Midwives Bill 2010 are broadly in line with the provisions of the Medical Practitioners Act 2007 and the Health and Social Care Professionals Act 2005. These Acts and the Pharmacy Act 2007 are consistent with the commitment in the health strategy "Quality and Fairness - A Health System for You" to strengthen and expand provisions for the statutory registration of health professionals. The Bill also reflects recommendations contained in the report of the commission on nursing, delivered in 1998. Therefore, this Bill is a major component of a suite of legislation aimed at improving patient safety and ensuring the full confidence of the public in the governance of these professions.

There has been broad consultation on the Bill. I published the draft for public consultation and I was very encouraged by the fact that more than 200 individuals, organisations and representative groups made submissions on the proposals. The depth and breadth of the submissions reflected the interest and concerns of a wide range of stakeholders. Many elements of the Bill reflect the suggestions made and as a result, the legislation supports both the protection of the public and will also benefit nurses and midwives by providing them with a modern regulatory framework comparable to other health care professionals.

I would like to draw attention to the title of the legislation before the House, which is The Nurses and Midwives Bill 2010. This is in recognition of midwifery as a separate and distinct profession and it is indeed fortuitous that yesterday was International Midwives Day. I would like to acknowledge the work and support midwives have given to the women of Ireland. Midwifery had a long tradition of recognition as a distinct profession from nursing. However, midwifery was subsumed into nursing in the Nurses Act 1950 and from then on the title "nurse" included "midwife". Midwives have sought the recognition of midwifery as a distinct profession for some time and the Bill recognises the views of the commission on nursing in 1998 in this regard. Midwifery as a separate profession also emerged as a theme in the public consultation undertaken by my Department.

It is important to note that child birth is regarded as a normal physiological event in a woman's life. Midwives are educated and trained to work with women to provide the necessary support, care and advice during pregnancy and labour and to provide care for newborn infants. A direct-entry midwifery undergraduate programme began in September 2006. Individuals who successfully graduate from this programme will have a midwifery qualification and not a nursing qualification. To reflect the recognition of midwifery as a distinct profession, the name of the regulatory body will change to An Bord Altranais agus Cnaimhseachais na hÉireann, or the Nursing and Midwifery Board of Ireland. In addition, I have provided for a statutory midwives committee to advise the board on matters pertaining to midwifery practice.

To ensure that all practising midwives have adequate clinical support, the legislation provides for the clinical supervision of midwives to enhance the support of midwifery practice. The legislation provides for the employer to be designated as a clinical supervising authority for midwives where these are employed by the Health Service Executive or a maternity service. In all other cases, the board will appoint a clinical supervising authority. The board may make rules on clinical supervising authorities that will include the requirements necessary of persons or bodies appointed as such and the need for all midwives to operate within a governance framework and to have adequate indemnity insurance. For the benefit of mothers and babies, I consider it essential that all midwives have this insurance to provide cover in the event of a negligence case. I acknowledge that insurance is not going to improve the protection and safety of mothers and babies. However, negligence cases involving obstetrics can result in substantial claims. If a midwife has no insurance, this could lead to a situation where negligence is proven but no payment can be made. This would add to the difficulties of families in these traumatic situations.

Part 2 of the Bill provides that the board will continue in being, but with a new name as outlined earlier. To underline that the focus of this legislation is the protection of the public, I have included this explicitly in the object of the board in section 8, which states the following.

The object of the board shall be the protection of the public in its dealings with nurses and midwives and the integrity of the practice of nursing and midwifery through the promotion of high standards of professional education, training and practice and professional conduct among nurses and midwives.

Section 9 sets out the functions of the board, including its obligation to perform its functions in the public interest. These functions place some significant additional obligations on the board and clearly demonstrate a major change from the operation of the existing board. I acknowledge that this will require a significant strengthening of the capacity of the organisation and that this represents a major increase in the demands that will be placed on the board. The specified functions include the registration of nurses and midwives and advanced nurse practitioner and advanced midwife practitioner posts. The functions also include approval of programmes of education, specification of standards of practice, fitness to practise functions, competency and advising both the public and me, as Minister.

The regulation of nurses and midwives must retain enough flexibility to ensure that the regulatory landscape adapts and develops with these professions. I have granted the board the power to make rules in section 13. The Bill sets out explicitly a range of matters where these rules can be made. These include the operation of committees, registration, the receiving of evidence by the preliminary proceedings committee and the fitness to practise committee, the setting of standards and criteria on nursing and midwifery education and training, clinical supervising authorities for midwives, requirements for indemnity insurance for midwives and any professional competence scheme.

To ensure greater transparency and accountability, any rule developed by the board will be subject to a period of public consultation and is subject to my approval as Minister for Health and Children. The use of public consultation in the development of rules is part of the Government's commitment to opening up the process of regulation and is in line with its "Better Regulation" guidelines. As rules on professional competence may have a financial aspect to them, the Minister for Finance will also have a role in the approval of rules for a competency scheme. When approved, rules will be laid before each House of the Oireachtas.

Section 14 provides for the board to prepare and publish guidelines on the manner in which the board proposes to perform its functions. It is very important that the public and the professions understand clearly the manner in which the board carries out its functions to meet its obligations under the Act. This will not only clarify what can be expected from the board, but will also provide a mechanism for accountability as to how the board meets its obligations in this regard.

In order to ensure that the board has the ability to perform its functions properly, it may be necessary for it to co-operate with other bodies. I have included a provision in section 15 that will allow the board to enter into such co-operation agreements for a range of specified purposes, including the sharing of information, in order to allow each body to perform its functions, to avoid duplication of activities, to allow for appropriate consultation and and to allow for the conduct of joint studies. This should improve efficiency and effectiveness of the regulatory body and the other relevant agencies.

To ensure openness and public accountability, provisions have been included in Parts 3 and 5 in respect of the production and publication of statements of strategy, annual business plans, annual reports and other documents. The board's annual accounts will be audited by the Comptroller and Auditor General and the chief executive officer will be obliged to appear before the Committee of Public Accounts of the Oireachtas. The laying of such documents before the Oireachtas will give the public a chance to see how the regulatory body is fulfilling its statutory delegated functions.

The work of nurses and midwives impacts on the lives of all citizens. Nurses are involved in all aspects of our health service. There is a need to reflect different stakeholders in the membership of the board. The board will no longer have a nursing and midwifery majority and the members will be drawn from various areas of the health service and the public. Given the importance of education and training in ensuring high standards of nursing and midwifery education, I have also included representatives from the education sector.

Section 22 specifies that the board will have 23 members, 11 of whom will be nurses or midwives. This is a reduction from the 29 board members provided for in the Nurses Act 1985, 18 of whom were nurses. Specifically, the remaining 12 members include nominations by the Medical Council, the Health and Social Care Professionals Council, the Health and Information Quality Authority and the Health Service Executive. A member will be nominated from the voluntary sector and the Minister for Education and Science will nominate a member from a third level establishment. In addition, there will be five members of the board who are not nurses or midwives and who have such qualifications, expertise, interests or experience that will enable them to make a contribution to the performance of the board's functions.

It is important to ensure representation from the various areas of nursing and midwifery and that these nurses and midwives come from both management and clinical practice. Of the 11 board members who are nurses or midwives, eight will be elected by the professions themselves. There will be nurse representatives from general, children's, psychiatric, intellectual disability and public health nursing and a midwife.