Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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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.

Brendan Howlin (Wexford, Labour)
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I call on Deputy Margaret Conlon. Is the Deputy sharing her time? Perhaps not. It is a 20-minute slot.

Margaret Conlon (Cavan-Monaghan, Fianna Fail)
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Yes. I have ten minutes and Deputy Cyprian Brady has ten.

Brendan Howlin (Wexford, Labour)
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Very good.

Margaret Conlon (Cavan-Monaghan, Fianna Fail)
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I welcome the opportunity to contribute to the debate on the Nurses and Midwives Bill. I acknowledge that Irish nurses and midwives are renowned all over the world. As Deputy Ó Caoláin stated, all of us have had experience at first-hand of their professional and caring nature. I wish to put on record my appreciation of the great work they do. As was noted, they do not always get the recognition they deserve in media commentary and mention.

Nurses and midwives have been to the forefront in the health care profession in progressing and changing their roles to meet the needs of their patients, always with a patient-centred focus. They perform critical functions. Nurses and midwives are often the first contact person people will meet in the health service. There is a very special relationship between the nurse or midwife and the expectant mother. I commend them for their professionalism and caring nature. They take their responsibilities very seriously. They carry out their daily functions to an extremely high standard and deliver a service to thousands on a daily basis, often in a quiet manner. They do so to enhance our health service.

It is heartening to see that nursing and midwifery are still popular choices among our young students. Leaving certificate students remain very interested in the profession. They see it as a caring profession, one where their individual characters, personalities and skills could, and in the future will be used to provide a vital service to patients.

Since the Nurses Act was introduced in 1985 we have witnessed major changes in our health services. These are reflected in the way services are delivered to the public. In more recent times we have seen a greater concentration in the delivery of services in the community with the setting up of the primary care teams and centres where services are delivered to patients in a much more community-based focus.

The public is looking for improvements in patient safety and this,in itself, would help to build patient confidence. I welcome the fact that more than 200 individuals, organisations and representative groups engaged in the consultation process. They saw it as important, felt they had something they wished to contribute and wanted their views to be taken into consideration. Those people have the benefit of the working experience and of dealing with patients. The Minister for Health and Children, Deputy Mary Harney, reflected carefully on these submissions in the preparation of this Bill to ensure the balance was right, that the public was protected and that nurses and midwives were benefiting by the putting in place of a proper framework. That will ensure they are dealt with in a manner comparable to other health care professionals.

I welcome that the word "midwives" is used in the Title. It is very important that they are recognised as being separate and distinct from nurses because, since the 1950s, midwives have been classed under the banner of nursing. I welcome that the group will be seen as distinct and the name of the body will reflect that in the nursing and midwifery board of Ireland.

The board's objective will be to protect the public in its dealings with nurses and midwives and the integrity of the practising of nursing and midwifery through the promotion of higher standards of professional education, training, practice and professional conduct among nurses and midwives. I welcome that the Minister has broadened the membership of the board to include the many different stakeholders in the health service, the public and the education sector. It is a good and balanced mix.

Nurses and midwives will have the opportunity to elect eight representatives to the board and at least three of the members must be engaged in clinical practice, which is very important. These people have valuable expertise and information to share from daily contact with patients and the public.

I welcome the new register for advanced nurse practitioners and advanced midwife practitioners. These roles are clearly defined and these nurses and midwives work at an advanced level. In order to have public protection, it is necessary for structures and governance procedures to be in place. There is a demand for a comprehensive fitness to practise structure, which can act in a speedy and appropriate manner when individuals make a complaint. One would hope that would be the exception rather than the norm.

Complaints will be assessed by the preliminary proceedings committee before the board makes a decision on the necessity to hold a full fitness to practise inquiry. Investigators will be appointed if necessary to facilitate investigations, which is very important for both patient and public confidence. A mediation process will deal with less serious complaints. There are nine grounds on which people can complain, including professional misconduct, poor professional performance and inappropriate behaviour. To have those listed in a clear manner will be of great assistance to the public.

In this country our nurses and midwives have a very high standard of education and training which is recognised the world over. The new degree programme has contributed in a positive way but nurses and midwives, like all other professionals, require ongoing professional development. Gone are the days when a person could qualify and just get a degree; there is a great need for ongoing professional development and support for all professionals, and specifically nurses and midwives. This development contributes to the maintenance of a very high level of competence, which ensures that patient safety is rightly at the heart of everything.

That issue is the focus of this Bill and it will ensure greater public confidence in the services provided while supporting and enhancing the high standards in education, training and competence in nurses and midwives. Like the Minister, I look forward to its early enactment following careful consideration on Committee Stage.

Cyprian Brady (Dublin Central, Fianna Fail)
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I welcome the opportunity to briefly contribute to this debate as this Bill will bring fundamental changes to the way nurses and midwives go about their business. The profession is often taken for granted, as it was in the past. As previous speakers have mentioned, Irish nursing has always had a good reputation not just within Ireland but internationally. There has always been a big demand for Irish-trained nurses around the world and we must recognise the contribution of religious orders over many years in upholding that reputation, as they formed a big part of how nursing was portrayed in Ireland.

The profession, particularly midwifery and specialised nursing areas, changes on an almost daily basis. There are new medical techniques, medications and treatments almost weekly and nursing plays a significant part in how those treatments are presented to people. People are very vulnerable in hospital, especially in maternity cases, and patients expect and deserve the highest standards. This Bill will ensure transparency and accountability in the profession for the patients and those using the services of nurses and midwives. At the same time it will provide adequate protection to those professionals providing the service, which is a key element of the Bill. It will ensure protection on both sides of the equation as there will be adequate coverage in how a patient is treated while protecting the professionals.

There are very strong requirements under the Bill relating to regulation and governance which cover nursing in general and the midwifery area in particular. The protection exists for both clients and practitioners through the new requirements. For example, there must be adequate insurance and there are stringent prohibitions on unregistered nurses. There is an adequate registration process with a constant review, which is a key element. Ongoing review of how nurses are trained and educated, and how they fulfil daily duties, is a fundamental part of the Bill.

The Minister for Health and Children, Deputy Mary Harney, mentioned in her speech that the educational requirements for nursing have changed drastically over a number of years. The introduction of degree qualifications and ongoing training and education while in the job has led to people being highly experienced and qualified, particularly in the specialist areas of nursing. The nursing profession today is a far cry from the days when nurses were not given proper recognition and treated differently. People took the service for granted and patients automatically assumed that only a basic service was provided by nurses.

The changes from the past number of years have ensured that nurses in particular, along with midwives, get recognition of the importance of their service. That has come about as a direct result of the change in the educational requirements in the professions. This Bill further enhances the opportunities for the recognition of those qualifications, specifically by ensuring that employers and management in hospitals are obliged to facilitate nurses and midwives in maintaining their professional competence.

It has always been an issue with nurses that if they wanted to go for promotion or change specialties, in many cases they had to do it in their own time. The job is stressful and onerous enough without that. This legislation will ensure that those with responsibility, including the HSE, will be obliged to facilitate ongoing training and educational opportunities for nurses and midwives. That will be a significant improvement to the service.

The spotlight has usually only been put on the nursing profession when there was a particularly nasty case of malpractice or abuse ending up in the media. As a result of the highly personal nature of nursing, staff often find themselves in a position where they are open to false accusations while patients suffer due to incompetence.